Valley Fever- that's my Lyme Disease!

So there are certain regional diseases that veterinarians and human doctors know well, because they see them all the time, but once you get out of the area, you don't see them, so they recede into the distant parts of your memory (filed somewhere with disease information about turtles, pigs and chicken poop- all things I needed to know about for my national board exam, but then I promptly drank a half bottle of wine to forget it all).  Sometimes, especially us older medical professionals forget to look for the "Zebras" as they are called.  90% of my day is spent treating the same things I've been seeing for the past decade.  I've seen so many ear infections, I think I've actually had my ear infection "spiel" in my dreams.  Most of the time, even before we go into the exam room, just with a basic history, understanding of the breed and our medical knowledge we have a good hunch as to what's going on.  That doesn't minimize the need for diagnostics and more inform

ation to confirm our hunch, but it narrows our focus.

Sometimes, when we forget to ask about travel history, or we get in the zone of seeing the same thing, over and over, we can miss things, or feel totally out of whack when something that doesn't meet the norm happens.   Having a history as an ER doctor helps me remember to look for the zebras- and to be extra cautious about things.  Dogs with elevated liver enzymes, or the possibility of?  I"m not sticking that jugular (because I remember having to manage a case where the referring vet did that and the dog didn't clot and the saga....).  Yep, in the ER you see the 0.5% of cases that end up really bad.

I've also worked in different areas of the country.  Where I went to school in Michigan, a little over a decade ago, I only saw one case of Lyme disease.  It wasn't very prevalent at that time.  Then I worked on the East Coast.  I saw Lyme Disease all of the time!  Other than the rare cases that got horrible kidney failure from Lyme Disease, I was able to be a hero with a simple prescription of antibiotics.  It was cool.  Take a sick, anorexic, limping dog back to healthy in a couple days- that's my kind of "fix-it".

Then I moved to Arizona and learned all about Valley Fever, or coccidiodmycosis.  Just like 25% of the cases on the East Coast tested positive for Lyme Disease, about 25% dogs in Arizona tested positive for Valley Fever.  Let me tell you- just like the unruliness of the Southwest of Old, this disease is feisty and difficult.  It doesn't go away with 30 days of antibiotics like Lyme Disease- No- it has to take 6 months or longer of anti-fungal therapy.  It also crosses the blood-brain barrier and causes seizures, fluid in the lungs, lymph nodes that look like lymphoma and so on.  It's a nasty bugger.  I used to fight it on a daily basis.  Whenever I have a case now with enlarged lymph nodes, I first ask the owners if they could have traveled to the Southwest, because it can look a lot like lymphoma and the treatment is the opposite.  A medical doctor friend of mine said it's the same in people and whenever people get accidentally diagnosed with lymphoma instead of the fungal disease (for example people who vacation in Arizona and are exposed to it and then get sick when they get back home).  They get treated with chemotherapy and end up REALLY sick or can even die because treating an infection with chemotherapy is never a good idea.

Recently, I had a moment in an exam room where I thought the owners might possibly have gone into shock.  They had moved from Arizona- the same part that I had once lived in.  They brought a dog to the East Coast who they knew had Valley Fever- but I was the first veterinarian they had met on the East that was familiar with it.  I rattled off the info I remembered, and told them I would double check because I hadn't dealt with it in a while and wanted to make sure nothing I had changed and make sure I was remembering it right.  They sat in shock as I explained that all the symptoms their dog had that the ER vet and other vet's hadn't explained could possibly be explained by Valley Fever (I gave them the caveat that it was also possible it was caused by something else- because remember I was an ER vet and I've seen some wacky stuff).  I then asked them if they had gotten info off of the "Valley Fever Center for Excellence".  "The What,' they asked.   The "Valley Fever Center for Excellence, I repeated.

Their mouths almost looked like they dropped a couple of inches.  "Uh- there's a website that has all this info on it."  As I rattled off what I remembered from ten years ago, I got on the website in the computer in the room with them.  Yep, 10 years later, my memory still held up and I was correct with what I was saying.  My husband would be shocked by this as I can't remember simple tasks at home and get distracted easily.  I try to explain that there's a lot stuck in my brain and sometimes the short-term memory get's the short end.  So- the moral of the story is- you never know how helpful moving around the country can be- or how helpful it is to have medical professionals who know a little bit of everything (though we all hope to know a lot of everything!).