Sarah Fields of Modesto is another example of how the West Nile virus preyed on the young and healthy this summer in the Northern San Joaquin Valley.
The 36-year-old mother of two was a regular at the gym and salon before she was bitten by mosquitoes outside her home near Vintage Faire Mall. The family was spending time in the backyard because the home’s air conditioning had failed.
Striking in June, the severe illness suspended the social life enjoyed by Fields and her husband, Lance, and forced her to take leave from her job as a marketing vice president for a national company.
Even worse, the disease paralyzed her left leg, and she’s afraid she may never walk normally again.
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The illness started with flulike symptoms, a rash on her face and pain in her joints. Before long, violent tremors at night woke her from sleep. She suffered blinding seizures that felt as if her body were being electrocuted, she said.
Fields spent almost a week at Doctors Medical Center, where doctors ruled out multiple sclerosis and a brain tumor. She was released from the hospital without a diagnosis but, a week later, county public health told her she had tested positive for West Nile.
Fields slept about 20 hours a day for the next six weeks. She slept in her daughter’s downstairs bedroom, calling or texting her daughter when she needed a glass of water or company. Fields had to bear crawling up the stairs to reach the master bedroom and home office.
The Modesto resident, and other Stanislaus County residents sickened by the disease this year, live in one of California’s hot spots for the West Nile virus. The 35 cases is the highest count since 2005. The county’s incidence rate of 5.96 per 100,000 this year is the fourth highest in the state.
There is no vaccine to protect residents against the endemic virus spread by mosquito bites, and there are no drugs to treat the patients who are hospitalized. People trying to recover don’t always get the answers they need from the medical profession.
According to Fields, who supports her left side with a crutch, one doctor told her, “You will just have to get over it.”
Others sidetracked by the virus include UC Berkeley sophomore Abbey Murphy of Modesto, who is missing the fall semester, and Delta College student Shamit Kishore of Lathrop.
Two 65-year-old men from Stanislaus County died from the illness this year. Another man was stricken in July and is now a quadriplegic in a Modesto hospital. He was taught to communicate with nurses by blinking his eyes, a hospital official said.
The county residents who have been sickened since the virus first was detected here in 2004 could fill a school gymnasium. But the number – 265 – is not great and the region lacks the political clout to lobby government for a vaccine. The disease has killed six county residents.
Statewide, 2,351 people have suffered from the devastating neuroinvasive form of the illness, 169 have died and 2,117 have been sickened by West Nile fever since 2003. It’s generally believed cases are under-reported; the state relies on county health departments to track the illness.
Treatment plan laid out
Fields was left with no movement in her left hip, hamstring and foot. An MRI revealed swelling in two areas of her spine and damage to the myelin coating over the nerve tissue. She could permanently lose function in the leg if the muscles were to atrophy from inaction.
Fields was able to find a doctor who developed a treatment plan for her and cared about her condition, she said. Her care includes monthly visits with the internal medicine doctor, chiropractic treatments, physical therapy, yoga and therapeutic massage, all at the same center.
She soon will see a therapist who works with stroke patients.
Fields is a patient at the Tremayne Center for Medicine in Modesto, described as a comprehensive internal medicine practice. Dr. Paula Tremayne said Fields was confused, in constant pain and could barely walk during her first exam July 18.
Fields was amazed when Tremayne called her at home that evening to send a detailed treatment plan she had developed.
Tremayne said West Nile encephalitis attacks the nervous system and causes a strokelike syndrome. Patients suffering paralysis need to see a doctor who will fully explain what has happened, and they need to begin therapy promptly. “If the therapy were delayed, she won’t regain her strength and may always have neuropathic pain,” the physician said.
Chiropractor Jose Hernandez has worked on the muscles in Fields’ lower back, which restored movement in her big toe. Hernandez said his practice is not about cracking backs. He uses a percussive device on Fields to get the neuromuscular loop working again.
The goal of all the therapy for Fields is restoring the connection between the brain, nerves and muscles on her left side. When she walks, her left side dips and she drags her left foot.
Fields has sessions with a special yoga teacher, which helps with balance and restoring strength. “It helps refocus your brain,” Fields said. “It helps with fatigue, restoring muscle strength, and restores the nerve and brain connection.”
Tremayne said she has no other West Nile patients and does not claim to have a cure. For the next year, the physician will review blood tests to look for any health condition that made Fields vulnerable to West Nile. “You and I are bitten and we don’t get sick,” Tremayne said. “I tend to believe there may be an underlying condition that predisposes them to the illness.”
Less than 1 percent
The majority of those infected with the virus have no symptoms, and less than 1 percent result in a debilitating case. For victims of West Nile encephalitis or meningitis, the ordeal may include severe headaches, fever, vomiting, seizures, disorientation, coma or death.
Dr. Charles Chiu, associate professor of laboratory medicine at the University of California at San Francisco, said in full-blown cases of West Nile, the virus causes brain inflammation and infects neurons in gray matter that control motor functions. It may also attack the spinal cord, possibly triggering an immune response that damages the myelin cover and disrupts nerve impulses.
Chiu said one of the first West Nile cases in California was a professional water skier who suffered career-ending paralysis. In his experience with West Nile patients, a third of those with spinal-cord problems completely recover, a third partially recover and a third do not recover.
In absence of medication to stop the virus, hospitalized patients are supported with rest, intravenous fluids and medication for pain and seizures, while their bodies attempt to fight the infection.
Chiu said experimental treatments have been tested in clinical trials, such as a lab-made serum mirroring the antibodies of previously infected patients who recovered, but there were no clear results. Tests are just starting to see if cloned antibodies could affect the virus.
The disease’s small caseload casts doubt on whether it’s cost-effective for drug manufacturers to develop a vaccine. “It would likely be a vaccine for high-risk individuals,” Chiu said. “Since it occurs in such a small percentage of the population, it’s not clear if there is a commercial model for producing vaccine.”
The case numbers may be small, but those afflicted often say it was the worst experience of their lives.
‘It’s a very slow recovery’
Former Modesto resident Nancy Halcomb was in a coma for five days, spent weeks in the hospital and five weeks in a rehabilitation center in 2009. Halcomb said she did not understand what was going on, was in pain and mostly cried.
After she returned home, Medicare and her veterans insurance paid for a therapist to come to her home and teach her to walk. The daily care received from her daughter was invaluable, she added.
Five years later, Halcomb still has balance problems and has fallen several times. “It is a very slow recovery,” said Halcomb, who now lives in Idaho. “I wish they would find something where you can get an inoculation to keep you from getting it.”
When David Jackson was hospitalized in 2008, the Salida resident did not know where he was, did not recognize his wife and pulled out his intravenous lines, he said. He was packed in ice to break a temperature near 105 and remained in the hospital for 11 days. He returned home weak and “shook like I had Parkinson’s disease,” he said.
Now 56, Jackson has an irregular heartbeat that his doctors suspect is a long-term symptom of West Nile, he said. Doctors found that he stopped breathing numerous times during sleep studies. Because sleep apnea is often linked with cardiac arrhythmia, cardiologists are treating his sleep disorder.
“(West Nile) scrambled my brains, and my brain is not always sending a signal for me to breathe,” said Jackson, who is retired from a career in state corrections and runs a home inspection business. In bed, he wears a device that forces air into his lungs when sleep apnea occurs. He makes sure to take it on weekend trips with his wife to Half Moon Bay.
Dolores Roberts of Modesto exemplifies the West Nile patient who got better with minimal care. In 2012, Roberts was pictured in The Bee undergoing rehab therapy for the severe effects of West Nile encephalitis. After returning home, she had one month of outpatient therapy at English Oaks Nursing Center and then exercised with a walker to regain her strength.
“My energy just seemed to come back slowly,” said Roberts, 68. “I would turn over in bed and have severe dizziness, and getting out of bed was difficult. It took about a year before I could finally feel like myself again.”
Vance Roget, medical director of Central Valley Specialty Hospital in Modesto, said that people who are stricken with West Nile encephalitis can see continuous recovery over the years. Young people, in particular, are known for brain plasticity, or the ability to recover brain activity.
The outcomes vary with spinal-cord problems because the virus infects the spine in much the same way as polio, he said. It’s important to start a rehabilitation program supervised by a physician, he said.
Patients who don’t fully recover may benefit from a brace. “If they were athletic and have good family support, all of that helps,” Roget said. “If the muscle is weak but not paralyzed, you can keep strengthening that area and they may need to do that the rest of their lives.”
Fields said doctors have told her there’s no guarantee of full recovery. Her therapists urge her to keep working and hope for the best.
She said the strange sensations of West Nile, such as buzzing in her head and leg, are disappearing. She has more movement in the foot, can lift the leg and put some pressure on it.
Her yoga exercises help her to loosen bound-up muscles and maintain a positive outlook. “Psychologically, it has helped that every day I’m at home doing something to promote recovery,” she said.