J. Greene

Q: I’ve been suffering with intestinal distress ever since a trip to Peru. But my health maintenance organization won’t do any further testing. How can I get parasite testing with the HMO picking up the tab?

A: I feel your pain. Literally. Two years ago I was in your position, as were several of my friends. Let me tell you my story of parasite woe, and then we’ll talk about solutions.

       It was my bachelorette party, and my seven closest friends and I were bonding over a luscious chocolate-and-fresh-raspberry dessert. All went well. I got married two days later and went on a brief honeymoon. It wasn't until seven days after consuming that dessert that my intestines went haywire and didn't let up for weeks.
      After a week or so of figuring I had a particularly nasty stomach flu, I started e-mailing and calling my friends, and each one had the same symptoms. By the time I got to the fourth sick friend, I called the local health department and told them I thought I had an outbreak on my hands. I could sense the public-health nurse on the other end of the line smiling a knowing smile, gesturing to her co-workers that they had another conspiracy theorist on the phone. But she began to take my story more seriously as I described my friends (who live all over the country) coming down with the same symptoms and having this one dessert in common. Cinching her interest was a newspaper clipping from the previous week announcing a new outbreak of the parasite cyclospora on — you guessed it — fresh raspberries.
      As it turned out, seven of the eight of us ended up sick. And it was interesting to note how differently we were all treated by our medical providers. My HMO doctor diagnosed me over the phone with stomach flu and said to check back if I had blood in my stool. That never happened, but the bloating, diarrhea and pain continued for weeks. By contrast, the public-health people asked me to give an immediate stool sample to the state health laboratory, where technicians were experienced in identifying this unusual parasite that had wreaked havoc all over the United States the previous spring. My sample came up positive. I called my doctor's office back, gave them this information and eventually got a broad-spectrum antibiotic that promptly knocked the beastie out.
      But my friends weren’t so lucky. A few suffered for six weeks before they could convince their doctors that they had a serious, if unusual, illness. One friend, a tough-as-nails newspaper editor, called me in tears after her HMO doctor refused to give her antibiotics, convinced she had malaria, of all things. Because my friend knew that I'd had a positive test for cyclospora, she asked specifically for a stool sample to be checked for the bug. The sample was taken, but they didn't check for cyclospora. When the negative result came in, they told her there was nothing wrong. And besides, they said, the doctor couldn't see her again for three weeks. Meanwhile, she was missing work and suffering through social engagements, where the sight of anything but plain rice turned her stomach to goo.
      Ultimately, most of our illnesses were pinpointed by public-health departments. In part, that was because we had an official outbreak that was being investigated by public-health officials, and they needed as much evidence as possible. It would have been nice if our doctors had been more aware of the cyclospora outbreak, but then the chances that they'd actually come across a case were pretty low.
      In your case, you're on your own so it might be difficult to get local health officials to test you, unless you have good evidence that you're part of some outbreak. It's worth a try, though — call the local or state health department and ask for someone who handles infectious disease outbreaks. They might have advice about your symptoms and what they might mean.
      Another option would be to contact a local university medical center, which might have a department specializing in travel medicine — diseases people pick up in other countries, or shots they need before they go on a trip. If your HMO doesn't have a relationship with the clinic, you might have to pay for a visit out of your own pocket. It could be worth it to identify whatever bug is ailing you.
      Keep in mind that it's hard for any doctor to know whether diarrhea or other intestinal problems are caused by stress, a common virus or some exotic bug. The best clue, unfortunately, is time. If you are sick for more than a week, or have bloody stool, then it's time to pressure your doctor's office and/or HMO for tests. If you encounter resistance, work your way up the ladder of responsibility, from your doctor's office to the HMO's customer-service people to the plan's medical director. Not everybody with diarrhea needs an expensive battery of tests to look for exotic bugs, but if you have long-standing symptoms and a reason to think you might have something weird, don't hesitate. As we found out, you may have to fight to get help evicting the bugs that have taken up residence in your gut.

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