Rocky Mountain spotted fever, despite its name, is not limited to the Rocky Mountains and, unlike Lyme disease, it can kill you if treatment is not started within five days of the onset of its symptoms: fever, headache, abdominal pain, throwing up and muscle pain.
According to the Arkansas Department of Health, 869 people caught Rocky Mountain spotted fever in Arkansas in 2015. In fact, it is the most common fatal tick-borne disease in the United States.
The fever is primarily transmitted by American dog ticks in an area stretching from Oklahoma to North Carolina and my home state of Virginia. But I didn't know that when I was bitten by an infected tick in April 2014. Here's how my case unfolded:
Saturday, April 18: I walk for 3 1/2 hours in the Manassas National Battlefield Park with my brother, niece and nephew. Before we leave the parking lot, we tuck our pants into our socks and spray ourselves with a DEET insect repellant.
After the hike, we check each other, find a few ticks and brush them off.
Sunday, April 19: My 15-year-old daughter Emma inspects me more thoroughly, and finds a tick attached to the skin in the middle of my back. She pulls it off. I figure I'm OK because it hasn't been in place for the 36 hours required for Lyme disease transmission.
Thursday, April 30: I swim a mile and do 10 minutes of leg lifts in the water. At dinnertime, I feel body aches. I attribute it to the extra 10 minutes in the pool -- and my head starts to hurt, acutely painful behind my eyes.
Friday, May 1: I wake up with all-over body aches and a temperature of 102 degrees. I stay in bed all day. My sister-in-law Liv picks up Emma and our dog Daisy, takes them to her home to stay until what we think is the flu passes. I take ibuprofen every six hours.
Sunday, May 3: I'm still as sick as I was Friday. In the late afternoon I take myself to an urgent care center, where I spend the next five hours. They do an X-ray and take blood. They think I might have hepatitis because my liver enzymes are elevated. They think I might have gallstones because of the pain I'm feeling, and they schedule me to see my primary care doctor first thing Monday, with a follow-up CT scan that day, too.
Monday, May 4: My primary-care doctor thinks I should be admitted to the hospital for observation because the blood work
and X-ray and CT scan haven't been able to determine what's wrong. My aches and fever continue. The hospital has no beds. Liv calls around in Maryland and is told that two take patients with my insurance. She drives me to one in Washington that evening. It turns out they can't hospitalize people with my insurance. The emergency room draws blood and keeps an eye on me while they find a bed at Holy Cross Hospital in Silver Spring, Md., that will be available in the morning. I will wait in the ER until then.
Tuesday, May 5: At Holy Cross they take blood and check my vital signs: heart rate, blood-oxygen level, blood pressure. My liver enzymes are rising. My white blood cell count is 2.5 so they have me in an isolation room under neutropenic precaution (meaning they're worried that I can catch any bug that's floating around). The oxygen level in my blood is too low, so they have me on oxygen. I text my sister in Indiana: "I'm a mess. Still don't know cause. How are you?"
By that evening, my breath is getting shallow. The nurses check my lung sounds and then, suddenly, the room is full of doctors and nurses: It's the critical care team, called in when a patient appears to be going into organ failure. Liv is standing across the room watching. She looks worried, and I wonder why. I'm surrounded by medical professionals, and so I figure: What could possibly go wrong?
They see that my lungs are full of fluid. They start me on Lasix to drain the fluid, lung treatments, steroids and an IV antibiotic, which is the standard treatment for Rocky Mountain spotted fever. This is prescribed by the team's infectious-disease doctor, the first to suspect Rocky Mountain because of the tick bite, which I had mentioned to every other doctor along the way, combined with the sudden appearance of a rash on my arms and chest.
One of the doctors, a critical care specialist, thinks that's not correct, that I have interstitial lung disease, because of my history of smoking, even though I'd quit 3 1/2 years before. I ask if the antibiotics will hurt me. "No," she says. "But it's not going to help, either." Luckily, the infectious-disease doc's assessment carries the day, and they stick with the antibiotics.
Wednesday, May 6: I am responding to the antibiotics. My liver enzymes are back to normal, my temperature is down and the pain is subsiding, all of which seems to confirm to my doctors that I have Rocky Mountain spotted fever. The tricky part about this disease is that it can be confirmed only by a blood test 10 days to two months after infection symptoms appear -- too late for a doctor to decide whether to treat for it.
I am still very sick.
Thursday, May 7: In the afternoon, I feel good enough to walk over to the bathroom on my own, pulling my IV pole along. I get back to my bed, and a nurse comes rushing in. The heart monitor shows that my heart rate has spiked at 175. They do an echocardiogram and discover that I have atrial fibrillation, so they restrict my walking. They add a second IV line to my hand for a drip of cardizem, a heart medication, which causes my blood pressure to drop.
Friday, May 8: A cardiologist says that my fibrillation is a result of exhaustion. My heart will most likely be OK once I recover.
Saturday, May 9: I'm getting sick of being sick, and I start asking when I can go home. My doctors tell me that will happen when I am able to walk around without my heart rate spiking.
Sunday, May 10: Heart spikes continue whenever I walk. Although my blood pressure is back into the normal range, my doctor says they need to continue monitoring my heart, so I can't go home.
Monday, May 11: All my vital signs are returning to normal. Finally! This is 11 days after my symptoms appeared. I am still on IV fluids and antibiotics. I am told I will go home that day. In the afternoon, my primary hospital doctor tells me that my heart has converted back to a normal rhythm. I am elated that I won't have to take a blood thinner or have my heart shocked to get it back into a normal rhythm. All I need to do now is rest and recuperate at home for a week or so.
"In a couple of weeks, you will forget that you ever felt bad," she says.
Wednesday, May 13: I hear birds singing outside when I wake up in my own bedroom, and in the evening Emma and I take Daisy for a walk to the park -- not into the woods. I am tired, but mostly grateful for my sisters and the medical folks who helped me survive my illness and for this very ordinary day.
Jane Ashley is a psychotherapist in Virginia.
ActiveStyle on 01/25/2016