Slow day, RMSF vs. Valley Fever

Slow day with not much new information (being a weekend) and not much change that I can see. Better than a week ago, not as good as just before that. Denise was "out" just about the whole time (Ativan & morphine). They also started an insulin drip again so they won't have to jab her whenever the blood sugar's too high from the TPN IV drip. That I saw, her fever didn't cross 103. Her oxygen concentration was turned up to 50% late last night, but was 40% the whole time I was there. Heart stayed at 132 bpm on average, higher during a coughing fit or obvious discomfort from turning. Breathing hovered all over the 30s. And again, I'm not feeling well, and will not be going over to the hospital tonight.

I just remembered a comment posted weeks & weeks ago asking why we started off with a diagnosis of Rocky Mountain Spotted Fever (RMSF) and then it changed to Valley Fever. Great question... one that we asked, with a great deal of frustration. The reason is that the doctors made the best guess at the time, based on symptoms (very similar) and where we had been (in Tennessee, trying to buy a house). RMSF is endemic to where we were, but difficult to diagnose, requiring tests with a time span in between. According to all web sites I checked, the treatment for RMSF starts before the diagnosis can be confirmed positive. That's what they did with Denise. Then, if I remember correctly, one culture of four started showing a fungus. The doctors thought it was probably just a fluke, but started antifungal meds just in case. It turned out that the fungus was cocci, the cause of Valley Fever.
Denise grew up on a farm in Illinois, then spent her JH & HS years in the central valley of California, where Valley Fever is common. We had been there to visit her parents many times, and the only problems we ever had was some congestion if we stayed too long. Many people are exposed to the cocci, and in healthy people the problem doesn't get beyond feeling like a bad cold or flu. Last winter was very wet for us in southern California, and according to one web site, the cocci fungus grew like crazy in the moisture. Then the heat came & dried it all out on the surface of the ground, being kicked up by wind, cattle, traffic, etc. In May & June, Denise went to visit her folks with the kids so I could do some home improvement projects without anyone under foot. About that time, Denise was at her third trimester of pregnancy (high risk group) and gestationally diabetic (diabetics also being in the high risk group). We may never know when the fungus first got into her system, how long it may have lay dormant, or what triggered the cocci to start making her sick. But it went beyond the usual infection of the lungs (causing the aforementioned cold & flu symptoms), and spread to other systems, which is called Disseminated Valley Fever. It's very rare to have it get that far (though we have received emails from people that have had Valley Fever in all stages), and it's got a high mortality rate. The last batch of cultures have not shown the cocci, but Denise would need to be on antifungal meds indefinitely anyway. The infections we're dealing with now are apparently common hospital-related infections, but just as devastating. If you'd like to really bone up on Valley Fever, check the link on the blog site for the Valley Fever Center for Excellence. Yes, the site looks a little bit goofy, but the resources link from that site is about as exhaustive as I've found.

In the mean time, keep praying/thinking/working us through this. Specifically, Denise needs comfort/rest/sleep, infections & fever need to go, heart & breathing rate need to slow down, heart needs to be able to squeeze out more blood with each beat, GI tract needs to work consistently (it's on-again, off-again), liver & kidneys need to function better (currently dialysis every few days is helping quite nicely), breathing/oxygenation needs to maintain or get better (so far, so good, considering she's on a ventilator). So everybody write that list down and tack it on the fridge.

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