1 Valley Fever It was hard to distinguish which part of the property was the actual yard without any grass to define it. Most houses in the desert didn t have sidewalks or curbs, at least not in Cave Creek. Set back about forty feet from the oiled dirt road was our house, peeking through Palo Verde and Mesquite trees, and clumps of Creosote bushes that smelled like rain when you rubbed their leaves. One giant, prickly pear cactus looked wildly overgrown and was way too close to the house. It was clean-up and clear-out the yard day, and that cactus was the first to go. The sunrise was vibrant and I could already feel the temperature rising. The Arizona heat would quickly reach 112 degrees, so we had a mental deadline to dig up the prickly pear by midmorning. My husband was wearing a thin long sleeve shirt, pulled out over his jeans, and a bandana draped under his ball cap to cover the back of his neck. He drove a skidsteer tractor to clear out the brush back and forth in short stints, it created a constant cloud of fine dirt. Al bounded in and out of the dust cloud, barking, wagging his tail, and howling at the commotion. His silver-gray Weimaraner coat turned brown in a matter of minutes. It was a scene that was repeated many times in the short eighteen months we lived there. We both thought we would have lived there much longer, but the FOR SALE sign hit the front yard and life was moving forward. We were leaving the dry, dusty Arizona desert for the high desert of Boise. It turns out we didn t really leave the dust. It hitched a ride. Probably on the tires of our car or in boxes that were loosely packed in the garage waiting for moving-day. Who knows? But it most definitely followed us. Somehow, air-borne mold spores had lodged themselves deep in the lungs of unsuspecting carriers: my husband, Todd and our dog, Al. Al got it the worst. He lived in it.
2 Al had been sleeping on the rug in our new family room. Butter yellow walls and clean white trim, so different from the southwestern colors in Cave Creek. It looked lighter. And felt lighter. We needed the change. The doorbell rang. Al jerked his body to get up, while I answered the door. Hi, I m Carrie she said. And pointed back across the street to the big blue house. I ve been meaning to stop by and welcome you to the neighborhood. She handed me a paper plate of brownies. How nice of you, I said. Smiling but distracted by Al s behavior. I m Mindy. I held out my hand to shake hers. My husband and I just moved from Arizona. Al tried to push himself up, barely lifting his upper body, but plopped back down. He tried again and slowly got up on all four legs. He walked toward the door limping, picking up his front right paw with every step. I noticed a small lump on his shoulder, taking note to keep an eye on it. Come here buddy what s goin on? Dr. Stoenner said. He grabbed Al by the collar and with his free hand rubbed the protruding lump. Looks like it hurts! He rubbed the rest of Al s body and felt down his legs, then massaged his long, grey ears with both hands and lingered in observation at the large lump on Al s front shoulder. I d like to take some x-rays. When did you first notice the lump? he said. About two months ago my voice rising at ago because I was embarrassed I had waited so long to get him in It was a lot smaller.
3 There was silence for a few seconds. I let out a deep sigh and rolled my eyes upward, mad at myself for waiting. A week later I was back in the same room, with Todd this time, and listened to the vet explain the x-rays. He diagnosed Al with bone cancer because of the tumor s rapid growth and suggested what to do next. Those are the options? I said. Biopsy. Cancer treatments. Or wait. And watch him get worse, then have to put him down. Dr. Stoenner asked if we had done any recent traveling, specifically to warm climate country. That s random I thought and told him the only traveling we had done was our move from Arizona to Boise, two months ago. His face showed an obvious epiphany, and he darted up to get a book from the shelf. I could see his mind reeling as he thumbed through the pages and landed on the one thing he was apparently searching for. He read silently, then inaudibly. Some words were clear: Southwest. Region. Indigenous. Spore. He told us it was a stretch but worth discussing and read aloud a new, possible diagnosis close to the one that I would read later: The most common symptom of valley fever in dogs is lameness of the limbs and swollen lymph nodes under the chin, in front of the shoulder blades, or behind the stifles. When soils containing the fungus are disturbed and dust is raised, spores may be inhaled with the dust. Once inside the lung, the spore transforms itself into a larger, multicellular structure called a spherule. The spherule continues to grow and will eventually burst, releasing endospores which develop into new spherules, and then repeats the cycle. Of all the people infected with Valley Fever, one or more out of 200 will develop the disseminated form, which is devastating, and can be fatal. Dogs are especially susceptible and often need long-term therapy with anti-fungal medication. Valley fever is endemic to the southwestern region of central Arizona, Central Valleys of California, southern Nevada, southern Utah, southern New Mexico, and western Texas, and Mexico. 1 Dr. Stoenner concluded there was no definitive test for Valley Fever, scientifically known as Coccidomycosis [kok-sid-e-oy-do-my-co-sis]; the only verifiable way to know it s in the body 1 www.casa.arizona.edu
4 is to treat it with anti-fungal medicine that reduces spores. If symptoms lessen or disappear, then it s diagnosed. Hope. We immediately began treating Al for Valley Fever. Within two weeks, his tumor was half the size and his lameness was lessening. Diagnosis confirmed. In the meantime, Todd had a pain in his lung. After three weeks of increasing pain, Todd finally gave in and saw a doctor. She suspected pneumonia. X-rays revealed a black spot on his lung. She told us it could be a number of things and there was no need to worry right now. I d like to consult another doctor and see you back in two weeks, she said. And prescribed medication for pain and asked him to come back sooner if the pain progressed. Black spot? My fear was rising. It was almost Christmas Eve. Time to watch It s a Wonderful Life. Todd loaded the movie while I loaded a huge bowl of popcorn and Red Vines into my arms. Feeling like a pregnant woman holding her belly, I squatted to sit down on the couch, only losing a few pieces of popcorn in the process. Al trotted over to eat them. Todd stood still in front of me. His shoulders and head slightly drooped he couldn t hide the knifing pain anymore. It hurt to breathe. Could you help move these two bar stools? Todd said. He thought standing between the stools and resting his arms on their high backs would relieve the pressure in his lung. He grabbed one of them and began moving it in the family room. In my gut, I knew something was terribly wrong. My stomach started burning. I helped him move the stools because he asked me to what I really wanted to do was start the car and head for the emergency room. It hurt to breathe.
5 He waited a week before going back to the doctor. He was nearly debilitated by pain. The second x-ray showed the black spot had doubled in size. We were told it looked like cancer. The only way to know for sure was a biopsy. For personal reasons, we were of the belief that biopsies could do just as much damage as the cancer itself. But now that it was facing us, we doubted what to do. We left the doctor s office that day, dumbfound, contemplating our decision. I walked out of the building into the damp Boise air and wondered what the next few months would be like. Suddenly I missed the warm Arizona sunsets. A few days later, going through the mail, I saw an envelope from the vet s office. Al s medical bill. I remembered the day we took Al in for his x-ray. The irony struck me. Both Todd and Al had been pre-diagnosed with cancer within weeks of each other. The vet s words flashed in my mind infection occurs when a spore is inhaled. The tractor. Arizona. Fine, dry dust. Al. Valley Fever! I spent the rest of the day researching with a new hope. I poured over symptoms, causes, and outcomes about the disease. It s not just prevalent in dogs. Todd s cancer symptoms mimicked those of Valley Fever: Valley Fever is primarily a disease of the lungs and may result in the development of nodules in the lung. These are small residual patches of infection that generally appear as solitary lesions, typically one to one-and-a-half inches in diameter, and often produce no symptoms. On a chest x-ray, these nodules resemble lung cancer. 2 Like the end of a mystery when all the pieces come together, things were starting to make sense. I remembered what Dr. Stoenner had read that fungal spores become airborne when soil is disturbed. Todd had moved dirt and cleared out brush for days, conjuring up ghostly spores that invisibly floated their way into his lungs. 2 www.vfce.arizona.edu
6 We made our case to the doctor. To ease her stress of our self-diagnosis, we shared with her the things we had read: how people from the southwest may carry dormant spores, revealing no symptoms, and that oftentimes because of a move to damper climates, the spores awaken. We also read that physicians in the northwest may not be familiar with this type of fungus, I said. Are you kidding me? the doctor said. I couldn t tell if she was mad or just shocked. Our dog has it too. He s been on antifungal medication and his symptoms are going away. I explained the vet s findings that the only definitive diagnosis is to take the meds and see what happens. Will you prescribe an antifungal? Todd said. It s not like we had time on our side. That stuff spreads fast. Al alerted us to that. She was open to this possible diagnosis and did a quick reference-search of Valley Fever and for anti-fungal medications. We walked out of the clinic with new hope and a prescription. I remember what Al had been like, right before I took him to that first vet appointment. He was so debilitated that Todd had to pick him up and carry him to the backyard so he could relieve himself. He still weighed over eighty pounds but had become helpless. Todd took care of him. They fought this together. Within six months, both of them were getting their life back. Todd s black spot was completely gone and his strength was almost back to normal. Al would never be off his meds. We tried it once, to give his body a break, and his tumor immediately began growing. That s the
7 eeriness about the spores they appear to be gone but never really are. Reactivity is lifelong. 3 Animals almost never completely get rid of them. Al never did. The day Al had to be put down, I couldn t stop crying. It was hard sitting at work trying to keep it together. Life is precious. His death made me feel that even more. Ten years had come and gone. I had to get my mind on something else. I called my husband, You feel like going for a bike ride? I sat on the back patio by the Syringas that shaded the damp green grass. I looked up through the giant Catalpa leaves at the increasing clouds while Todd put away the mountain bikes. No dust. No dirt. Home. He came out of the garage grabbing the side of his ribs. Are you okay? He hadn t had symptoms for years, but the fungus had left a knotty scar in his lung, a permanent reminder that it s never really over. Yeah. I m good. 3 www.vfce.arizona.edu