Galt resident Eric Penney was lying in the recovery room in January 2009, after he had been strapped down and had a tube shoved into this chest. Doctors rushed to do the emergency procedure after a needle biopsy to study the mass in his lung went awry and his lung collapsed.
The surgeon came in and finally delivered a diagnosis.
"He said, 'Well, I've got good news and bad news. You don't have cancer, but what you do have could kill you,'" Penney said.
The 59-year-old was diagnosed with a disease he had never heard of until that moment: valley fever. At the time, Penney had no idea that he would still be dealing with the lung disease and side effects from medication more than 2 1/2 years later.
Severe complications from valley fever are rare, but those who have suffered from it will never forget it.
It can cause shortness of breath, and medical complications like collapsed lungs, extreme joint pain and even death.
California's Central Valley is one of the few places in the world where people can get the infection, and the numbers in San Joaquin County are on the rise this year. As of Aug. 11, 51 cases were already reported this year, compared with 46 for all of 2010.
People get the disease from spores that live in the soil. The biggest hotspot for valley fever in San Joaquin County is in the southwest part of the county around Tracy, said Dr. Karen Furst, the county's public health officer.
"It's not totally clear why it's in the soil in some places and not in other places. Central Valley counties are trying to get a better understanding of why it grows in certain areas," Furst said.
The disease is not new. In 1994, there were 78 cases in San Joaquin County, the highest amount in the last 20 years. Former Lodi police chief Jerry Adams contracted the disease in 1993, when he was a captain in the police department.
He also had never heard of the disease.
"You are feeling pretty good one day and then the next day you are in a hospital bed, trying to figure out what is wrong with you," Adams said.
'I was in the right place at the wrong time'
June 26. Penney will always remember the day he contracted valley fever, even though he didn't know it at the time.
He was at a wedding in Fresno, and he remembers that it was windy and there was dust flying through the air.
"I was in the right place at the wrong time, and I just happened to inhale the spore, and it got into my left lung. The doctor later said it was just one of those things, that if I had had my head turned at the time I inhaled, then it never would've happened," Penney said.
About a month after going to the wedding, he started feeling a dull ache in his chest, but thought it was due to allergies. It went away briefly, but the discomfort was back at the end of September.
Penney went to the doctor, but it was not clear what was wrong.
Then, the week of Thanksgiving, he became very fatigued. He couldn't walk to the mailbox because he became too winded. He had trouble finishing sentences because he would lose his breath. He was so weak, his wife had to help him out of the bathtub.
The Friday after Thanksgiving, he was running a 104-degree fever and was diagnosed with pneumonia.
He took antibiotics throughout December, but he did not improve.
At the end of December, his doctor scheduled him for a CT scan. When it appeared that he might have lung cancer, they scheduled the needle biopsy.
The procedure involves doctors sticking a needle through the chest wall to get a tissue sample. Because of complications, it took them five tries to get the sample.
About two hours after the biopsy, Penney's lung collapsed.
They rushed him the emergency room, strapped him down, and without any pain killers or anesthesia, a doctor plunged a tube into his chest wall.
Aside from the pain, Penney has one striking memory from the procedure.
"The one nurse in the CT room when they were tubing me and doing the needle biopsy before that, she held my hand. That was her one job," he said.
During the months of uncertainty, Penney and his wife, Susan, were both scared because he never had been sick before and usually only had colds for a day.
"There was some anger on both our parts, not at each other, but at the situation. Why don't they know what's wrong? Why can't they fix me?" Penney said.
Once he received a diagnosis, Penney saw a slew of doctors and started researching the disease.
A doctor at Kaiser Permanente South Sacramento started prescribing him anti-fungal medicine to fight the mass in his lung, Penney said.
"He said, 'What you have is very serious, and it could kill you. To get better, you are going to have to do exactly what I tell you to do without fail, without question,'" Penney said.
Elusive symptoms, but sometimes deadly
About 60 percent of people exposed to valley fever never show symptoms. Of the 40 percent who do, most have flu-like symptoms, like fever, cough and headaches, then get over it, never knowing they have the disease, said Dr. Harold Lin, chief of infectious disease at Kaiser Permanente Fresno.
But a small percentage of people experience symptoms like pneumonia and joint and bone aches. Eventually, the disease can develop into nodules in the lung that look similar to lung cancer.
Advance forms of the infection also can disseminate to other parts of the body, which can trigger meningitis. That is the deadliest complication of valley fever.
"Why patients are getting really sick and other patients are not, we are not sure," Lin said.
Ethnicity plays a role. African-Americans and Filipinos are more likely to get sick from valley fever, Lin said. Also, people who have compromised immune systems, because they have HIV or are in the first trimester of pregnancy, are likely to show symptoms of the infection, he said. It is non-communicable.
Certain occupations like construction and agriculture workers have higher rates of the disease because they are exposed to dust frequently, Lin said.
And while there still needs to be more research on why some years have higher rates of infection than others, there seems to be more cases when there is a wet winter, Lin said.
"After the rain, you have more spores forming. You have the sun drying them out and then have more spores flying and more infection," he said.
At times, there can be an outbreak if a group of people are near a place where spores are in the air, Lin said.
So how can you prevent yourself from getting valley fever? There is not much to do, except avoid dust on windy days. Lin recommended anyone who would has a compromised immune system stay inside and keep their windows rolled up in the car.
He told the story of one of his Fresno patients who got infected in a matter of minutes. The man was driving through Bakersfield, and a car rolled over on the side of the road. He got out of his car to help for about 10 to 15 minutes.
"His whole body was covered by dust. About two to three weeks later, he came in with valley fever," Lin said.
Weeks of not knowing
For Adams, there was no single moment that he could pinpoint when he got valley fever.
He developed what he thought was walking pneumonia in 1993, and then started feeling better, similar to Penney. He was tested for valley fever but it came back negative, which Adams said he later found out often happens with skin tests.
But when he didn't respond to antibiotics, he went into Lodi Memorial Hospital before being transferred to St. Joseph's Hospital.
When he arrived, a surgical team was waiting for him. Doctors told Adams' wife that his right lung should have collapsed because the chest tube wasn't working.
They did surgery to relieve the pressure in his chest, and he remained in the hospital for three weeks. Doctors still did not know what was wrong with him because they did not retest him for valley fever.
"You don't have to be a cop too long to see the nurses come in and take a look ... and they are looking at you like you don't look so good," Adams said.
He reached a point where he still felt bad, but was well enough to get out of the hospital. About a month later, he felt a small abscess near his surgery scar, and that when he found out he had valley fever.
"The longer it goes on, you get really depressed and think, 'How come I'm not getting better?' It's just not something I would wish on anybody," he said.
Two different outcomes
Both men were immediately started on anti-fungal medications once they received the diagnosis, but Adams was healed in about a month, while Penney is still battling the disease more than three years after he was infected.
Several years after finishing treatment, Adams did experience some shortness of breath while hunting, especially in the Rockies, because of the scar tissue.
"It felt like there was a belt wrapped around my chest and it was one notch too tight," Adams said.
Since then, he has heard of several other people developing the disease. While working for the Governor's Office of Homeland Security, he was talking with a co-worker who had pneumonia, but it wouldn't go away.
Adams told them to get tested for valley fever, and it turns out that is what the co-worker had.
"You would think being in the Central Valley that it would be something doctors are more in tune to, because this is one of the few areas in the world where you can get valley fever," Adams said.
Penney also encourages anyone with pneumonia or flu-like symptoms to recommend their doctor test for valley fever.
"If I hadn't taken the medication, I probably would've developed meningitis and probably passed," Penney said.
Penney is still dealing with the effects of the medication and the valley fever.
He has developed painful bumps on his joints. He cannot close his fingers to make a fist, and has trouble opening bottles. His fingernails are so brittle they break easily and are deformed. He has skin rashes that make his head look like a tomato.
Some mornings, he has trouble walking because his feet hurt so bad. He has to side-step down the stairs clutching the railing.
Mentally, he has trouble remembering things. His wife, who has multiple sclerosis, will ask him to do something, and about five minutes later, he cannot remember what she asked him to do.
He recently had to hire a gardener because he could no longer keep up with the yard work.
"All these other doctors that I've seen, when I mention all of the anti-fungals I'm taking, they say, 'Yeah, no wonder you don't feel good. Look at all the medicine you are taking.'"
Yet despite all the challenges, his business as a fire sprinkler consultant has doubled over the last year and a half. He enjoys playing with his four grandchildren, and he has a fifth on the way.
"I just had the realization that the doctors are doing everything they can and there is no cure. It could come back and kill me, but we hope it doesn't. But to dwell on it, doesn't do you any good," he said.
He looks forward to a day when he no longer has complications from the valley fever, and it's inert. He would like to take his wife of 39 years to Hawaii, and he would also like to get his sports pilot license.
When people ask him how he is doing, he now says "great" instead of just "OK."
"I still don't feel like I did before I got it. I feel like something has clamped down over my whole body. I don't have the stamina. I don't have the strength. I don't have the mental sharpness that I had before the illness, but compared to what I felt like two years ago, I feel great," he said.