The final (?) word on my fungus

Well, I continue to get better. My hips are the only joints that still hurt at times (the Celebrex helps) and my lower legs, though not perfect, are in much better shape. But I do get very tired very easily, and often feel fatigued. I'm back at work, but not taking on too much.

There was some question on my diagnosis when my blood test for Coccidioides (the fungus) was negative...but I had elevated antibodies for the bacteria Streptococcus! An extreme case of Strep could cause similar symptoms, but I never had the hallmark sore throat. Plus blood tests for fungal infections are notoriously inaccurate.

So I went to see an infectious disease specialist at Beth Israel, Dr. Stanley Yancovitz, who was kindly recommended to me by some former antifungal clients. I mention him by name because he was great and I highly recommend him to anyone who ever needs an ID; but I digress... I told him the whole sordid tale and he did an exam—and he concurs with the fungal diagnosis. The elevated Strep antibodies were probably from a previous illness. There are other tests that could be done, but he felt that the clinical evidence for Valley Fever was overwhelming and I am getting better, so there was no need for them. A few more weeks of taking it easy and eventually I will be as good as new (or at least as good as I was).

The one interesting caveat is that he said I should always report it as part of my medical history because the fungus can remain dormant in your body for the rest of your life. Under normal circumstances I’ll never have another acute attack now that my immune system has put it in check; but if I’m ever severely immunosuppressed (eg, if I had an organ transplant) it could flare up again.

So what did I learn from all this? Fungal infections suck. Sporanox sucks. Side effects suck. A lot of doctors suck. But my friends and family don't suck. And neither do Stella D’oro Breakfast Treats.

The best medicine of all...me and my niece Ashley on my first “day out".


PS: Karen "MBL" Landes has recent posted a few comments/corrections under the post from our trip to Vega$. If you wish to read them, scroll down and click "comments" at the end of that post!

Bumps in the road (and all over me)

Some of you have asked for an update on my health so here's the latest...

After a few days of Sporanox and Celebrex (ever notice how many drug names end in "x" these days?!) I was feeling significantly better. As the swelling of my ankles started to go down, they also began to itch—which I assumed was related. But it got worse, and I began to notice hives all over my legs. A day later, they were all over my body—even my ears!

Here's a photo of the rash in its early hours (the later ones might scare the children):

By the way, the Brown shorts were a gift from Caitlyn Citrin. She went to Brown. I didn't. I was rejected. Not that I'm bitter and still harp on it almost 20 years later. But I digress...

The docs said it was a reaction to one of the meds. First I stopped the Celebrex, but it got worse (and of course, the pain in my joints returned to boot). I was a big, red, itchy beast who couldn't even sleep. Definitely a new low in this whole experience. But now I've stopped the Sporanox (the antifungal) and it's clearing up. I KNEW I should never have taken that crap! So it was a little sad that just as I was getting better I got worse, and I was indeed a sad sack. But happily I'm back on the road to recovery once again.

The interesting thing is that, at work, I generally write about life-saving drugs. And when you look at clinical trial data, even then, there are always patients who drop out of studies because of side effects. I’ve often wondered, “How can any side effect be so bad that you would stop taking a drug that might save your life?!” Well not that I was ever at death’s door, but I understand a little better now. For a day or two I didn’t give a crap about anything except getting rid of that rash.

So it set me back a little and now I missed my niece Ashley’s preschool graduation, which made me a little sad, too. But assuming I have no further problems I should be back in action by next week.

Thanks again as always for all your well wishes.

By the way, here’s my first product endorsement: Stella D’oro Breakfast Treats are now the Official Snack of the DougBlog:


I haven’t had them since I was a kid, but I got them again during my convalescence and they are deee-licious. And like the commercials used to say, “They’re not just for breakfast.”

Which makes you wonder why the call them “Breakfast Treats”, but again I digress…

I've got the fungus!

So I’ve decided to take a departure from my usual travel-related entries to report on something a little different: my invasive fungal infection!


Yes, it’s true. After writing about fungal infections and antifungal therapy for more than 11 years, I’ve actually contracted one. Oh, the searing irony. I have coccidioidomycosis, also known as “valley fever”. It’s an endemic fungal infection, meaning it only occurs in a certain area: the southwest. Arizona is the focus but it’s also found in parts of neighboring states. In fact, the name “valley fever” comes from its occurrence in the San Joaquin Valley of California. Here’s the culprit, a fungus called Coccidioides immitis:


Anyway, it’s very strange, after years of writing about fungal infections and their treatment, to be on the other side of one; so I thought I’d record my experience.

While it’s a common infection in Arizona, here in NY it’s something most doctors would never see; so getting a diagnosis can be a challenge. Here’s how mine happened…

About 2 weeks after I got home, I developed a dry cough (and thought nothing of it). Then about a week before my diagnosis, I began to feel sore in my joints—and again I thought nothing of it. But the soreness got worse every day. I went to a conference in Chicago, and by the end of my trip it was so severe I could barely walk after sitting or lying down. I was also very fatigued. And when I got home, I also noticed large red lumps on my legs and had a fever of 102!


Clearly something was wrong. I've never had a fever in my adult life. So the next morning I literally hobbled to my GP. I even packed a little bag because my condition was deteriorating so rapidly I thought I might end up in the hospital. Once there, about 10 doctors in the practice examined me. And they all scratched their heads (maybe there was a lice outbreak?). It was clearly an infection (apparently the bumps on my legs, called erythema nodosum, are an immunologic response) but no one knew what was causing it. The combination of symptoms didn’t match anything they’d ever seen. I knew I was in trouble when they started pulling out textbooks. They took a lung x-ray, which revealed suspicious nodules:


Check out the graceful curves of my clavicle. I think I might have the most beautiful clavicle in the world! But I digress...

Now here’s the fun part. They asked about my recent travel history, and I mentioned having been in the southwest. That didn’t spark anything in their minds, but it actually got me thinking…so I suggested coccidioidomycosis. After poo-pooing me, they looked it up in their textbooks and—lo and behold—I fit the description to a “T”! They all started to read about it, and I started to laugh: the idea of me having a fungal infection was just too funny, too surreal. Once or twice the physicians tried to comfort me because they thought I was crying, when in fact I was laughing.

The next day I visited a specialist who has actually treated patients with cocci, and he concurred with their (my?) diagnosis. We’re still waiting for the blood tests for the final word, but it seems pretty clear-cut. Clearly I had to have picked it up when I was in Arizona with Karen. You only get it by being there and inhaling the spores. Remember beautiful Antelope Canyon? Well the whole time Karen and I were in there it rained dust and sand and dirt on us. You can clearly see it in this photo:


So that might be where I got it. In fact, I zoomed in on the falling dust particles in that picture and guess what I found:


So now I’m on Sporanox (itraconazole) for the fungus and Celebrex and Tylenol for the joint pain and do seem to be getting better, slowly but surely. My ankles are swollen (my left foot looks like Shrek’s) but the rash and the pain are beginning to dissipate. I have headaches and fatigue and more recently developed conjunctivitis in my right eye (another common symptom), but again I seem to be getting a little better. So this is pretty much my life now:


To answer a few questions that many of you have asked me…

Is it contagious? Absolutely not. You can only get cocci by inhaling the spores yourself.

Can anyone get it? Anyone who lives in the endemic areas or travels through them, especially if you’re exposed to loose or recently upturned soil and/or high winds. Unlike many other fungal infections, you don’t have to be immunocompromised to get this one.

Are you gonna die? Only if LifeTime stops rerunning The Golden Girls. Cocci is rarely fatal, and then only when it infects major organs, particularly the brain.

How long until you get better? Hard to say. Sometimes it takes weeks, sometimes it takes months. Some people remain on therapy for years or the rest of their life. Happily I seem to be on the mend already, and I think I’ll be able to return to a regular life in another week or so. But I may have sore joints for a long time thereafter. That’s why they also call this disease “desert rheumatism”.

Where can I find more information? Click here for The Merck Manual Home Edition online. They have a good, brief overview of the disease. For more in-depth information, click here for the Valley Fever Center of Excellence. Located in Tucson (naturally), their Web site has a lot of good info, including an extensive Q&A.

Anyhoo, I’ll keep y’all updated. In the meantime, thanks for all the cookies, flowers, e-cards, and well wishes. They really help.

Because it turns out fungus is no fun.