Histo-what?

Imagine living in a rural farming community with rivers and streams flowing down the mountains and through the center of town. Imagine going to sleep with bats flying around your room and feeling lucky that they can’t bump into you inside your mosquito net. Imagine waking up to the call of the ever-present chickens around your home and community. And imagine making abono orgánico by digging up soil and mixing it with gallinazo.

I lived in such a community as a CEC volunteer and loved it. When else in your life can you live in such a beautiful place where you are welcome in every home, and people offer you brindi on every visit?

However, I did have intestinal woes which lasted much of my service in that community. At times I would stay in bed in the fetal position hoping the abdominal pain would go away. At other times I would make strategic trips around the community, knowing which latrines were well taken care of when nature made its urgent call. I downed enough antiparasitics, antibiotics, dewormers, and steroids to evict whatever may have been living in me at the time.

I returned home in late May of 2010. I immediately started education classes and accepted a position teaching high school Biology. As a full-time student with a full-time job as a first year teacher, I was exhausted on a daily basis. Who wouldn’t be? I still had a little cough I left Panama with, but overall I felt pretty good. I didn’t even get the flu or a cold from the variety of pathogens the kids seemed to fill my room with on a daily basis.ng the abdominal pain would go away. At other times I would make strategic trips around the community, knowing which latrines were well taken care of when nature made its urgent call. I downed enough antiparasitics, antibiotics, dewormers, and steroids to evict whatever may have been living in me at the time.

I started out this school year with a sore throat that just wouldn’t go away. I was seen by ten doctors and specialists who each mentioned they had never seen anything like it. Possible diagnoses included tuberculosis, parasitic infections, fungal infections, and even cancer. CT scans, bronchoscopy and laryngoscopy with cultures and biopsies, blood tests, and urine tests were all performed.

When several of the 35 tests came back positive, I was admitted to the hospital with a diagnosis of disseminated histoplasmosis. With Google on my side, I learned about the disease. Histoplasma capsulatum is found in soils in river valleys. Bird and bat droppings enrich the growth medium for the fungus causing highly contaminated soil. Histoplasmosis is caused by the inhalation of Histoplasma capsulatum spores from contaminated soil. The spores become airborne through disturbing contaminated soil. Patients who develop clinical manifestations of histoplasmosis are usually immunocompromised.

It all made sense. My community seemed like a perfect place for the fungus to grow. My job description made my contact with the spores likely. And months and months of chronic diarrhea would have certainly compromised my immune system. Plus, the first described case of histoplasmosis was made in Panama.

The infectious disease doctor described the likely course of events. The middle and upper lobes of my right lung were infected with histoplasmosis during my service and just chilled there without my awareness. It ate away a ping-pong sized hole which with time walled-off from the rest of my lung. Eventually the fungi entered my bloodstream and settled in my throat. It was there that the fungi ate away at my epiglottis and surrounding structures, swelling them up like a balloon and causing the pain, trouble breathing, and swallowing problems that kick-started my search for a diagnosis.

With a diagnosis, treatment began. I was started on Amphotericin B infusions through a PICC line (think chemo) lasting four hours each day. My reactions to the medicine eased through a week in the hospital by pre-medicating with Tylenol, Benadryl, and morphine. After another week of outpatient transfusions, I began treatment with Sporonox, an antifungal medicine that I will be taking daily for at least the next year.

I learned a few lessons through the course of diagnosis and treatment:

Document everything! Many of the drugs prescribed during my service were recorded in their Panamanian names that doctors here could not decipher. Some papers in my medical records requested from the Peace Corps Post-Service Unit were missing and others belonged to other volunteers, including a positive pregnancy test with the name and social security number of another PCV. Also some medical complaints were lost in translation: an infected bug bite for which an antibiotic was prescribed was recorded as swollen due to a fall. Keep a medical journal.

You know your body better than anyone. The general practitioners insisted that I had a viral infection when antibiotics didn’t work. So I started going to specialists and got the ball rolling. A radiologist kept me in isolation for an entire day thinking I had TB even though I didn’t have any other symptoms of the infection. So as soon as I was let out, I went to an Urgent Care for a TB test which was negative. A nurse in the hospital failed to follow the infusion protocol for my drug. So a call to the duty nurse who rectified the problem. Don’t be afraid to speak up.

Love your health insurance. I never thought health insurance was particularly important. I was young, healthy, and invincible. My employer paid my premium each month. I accidently signed up for the better plan this year and paid an additional $30/month out of my paycheck. Boy am I glad I did! The medical bills have added up to over $70,000 while the medication I now take costs about $1,000/month. My out-of-pocket has been about $5,000 so far. I would have been screwed without insurance.

Applying for FECA benefits is not scary. It seems like a daunting amount of paperwork to gather and months to wait when you feel like crud. My doctors were less than forthcoming with providing the required paperwork listed on the form (CA-2). After several requests, I finally sent in what I had and figured I would send any additional paperwork as requested. Just two weeks later, my case was accepted. Reimbursements were also not as difficult as listed on the Peace Corps website. FECA actually only requires one form (OWCP-915) and receipt to process a request instead of getting each provider to fill out a separate affidavit (OWCP-1500) and medical notes. Organize paperwork by provider, not date, to make things easier in the long run. And did I mention document and keep copies of everything?

I don’t mean to scare you with any of this, just keep you informed. I certainly don’t regret a minute of my service. I hope you stay healthy and enjoy your time in Panama!