She Kept Thinking About a Salad

Cedar Valley News
July 25, 2026
She Kept Thinking About a Salad
By Aisha Khalid

A woman came to see me a third time this month and opened by apologizing for wasting my time.

She had been sick since the middle of June. Not dramatically. Watery, crampy, tired, no appetite, a few pounds down. It would ease for two days, and she would decide she was better, and then it came back. We had done the ordinary stool testing after her second visit. Everything came back negative. I told her it was very likely a virus working through, and to come back if it did not settle.

She came back. On the third visit, she said the sentence that changed the whole afternoon.

She said, I keep thinking about a salad I ate.

I want to tell you about a parasite going around the country this summer, because one thing about it every reader ought to know, and it has nothing to do with being careful and everything to do with speaking up.

The parasite is called cyclospora. It arrives on fresh produce, not from person to person, so you cannot catch it from your family. It has caused a multistate outbreak this year, more than sixteen hundred confirmed cases, with investigators still tracing the source. Untreated, the illness can run a stop-and-start course for a month or more, which is exactly why people quit going to the doctor about it. They assume a thing which keeps easing must be getting better.

And here is the part which matters, and it is the reason I am writing this instead of something cheerier on a Saturday.

The routine test does not reliably find it.

Let me be precise, because this is not a complaint about laboratories. The standard stool examination uses stains this particular organism does not take up well. It is very small and it hides. Even the newer molecular panels do not all include it. And it is shed in bursts, so a person can be thoroughly infected, hand in a specimen on a quiet day, and be told truthfully, we found nothing.

The disease agency sent a notice to clinicians this month asking us to specifically request the test when the picture fits, precisely because the ordinary one might miss it.

Now sit with what it means from where I am sitting.

I cannot find this by looking harder. It depends on whether I thought to order a particular test, and whether I thought to depends almost entirely on something only the patient can hand me.

For most of what I do, I am the one holding the information. I read the numbers, I know what a body is doing before the person does, and my job is to translate. This is the reverse. Here the patient holds the piece I cannot reach on my own, and if she does not say it out loud, I will very likely reassure her instead. I did it twice with her.

Reassurance is right most of the time. It is what a family doctor says all week long, and it is usually true and usually kind. And once in a while it is the thing standing between somebody and a treatable diagnosis.

Here is what I would ask of you, and it is not a warning about salad.

If you have been unwell since early summer with a stomach illness which will not resolve, coming and going in waves, do not wait it out politely. Go in. And say two things plainly. Say how long it has actually been, in weeks, not the softened version. And say what fresh produce you remember eating before it started, even if it was a month ago and you feel foolish bringing up a salad.

And if the first test is negative and you are still sick, say so and go back. A single negative does not close the question here.

There is an ordinary antibiotic for this, and people get well on it.

My patient is better. She is annoyed with herself for waiting, and I have told her the waiting was not her mistake.

You are not being difficult when you say the thing again. You are handing me the only piece I do not have.

Cedar Valley News has a Facebook group. If you have comments and want to join the conversation, you are welcome. Was there a time you had to say the same thing twice before anyone listened? Come and tell us. And if we get something wrong, tell us, and we will run the correction. https://bit.ly/40p8jKy

Cedar Valley News is free, and it comes to your inbox every morning, six days a week. If this morning’s editorial was worth your time, please forward it to someone who would value it. And if someone forwarded it to you and you’d like your own each morning, just reply with the word “subscribe.”

This editorial is part of the fictional Cedar Valley News series, written by Evan Swensen, Publisher, and Claude Marshall, AI Developmental Editor. While the people and town of Cedar Valley are fictional, the illness and the guidance are real. Cyclosporiasis is an intestinal infection caused by the parasite Cyclospora cayetanensis, spread through contaminated fresh produce or water rather than person to person, and a multistate outbreak with more than sixteen hundred confirmed cases is under investigation this summer. In July 2026 the Centers for Disease Control and Prevention issued a health advisory asking clinicians to specifically request Cyclospora testing, because routine ova and parasite examinations might not reliably detect it and not all gastrointestinal molecular panels include it; CDC also notes the parasite is shed intermittently, so a single negative specimen does not rule out the diagnosis, and the infection is treated with an antibiotic regimen. Anyone with a prolonged or relapsing diarrheal illness should speak with a clinician; this editorial is not medical advice for any individual case.

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