rat lungworm disease

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Jack Russell Brauherr

Jack Russell Brauherr

Jack Russell Brauherr, a Puna, Hawai'i resident gardened, raised fruit trees and served as a volunteer firefighter until January of 2017, when he developed flu-like symptoms. He was able to fight them off at first, but by half way through February, he was suffering from delirium and became bedridden. When his brother brought him to the Hilo Medical Center, he was unconscious and stayed comatose for over a week.

Dr. Jon Martell, of the Hilo Medical Center, immediately suspected the disease and confirmed it with a spinal tap. He then started Brauherr on a treatment regimen that stepped quite a bit outside the conventional knowledge listed on the Center for Disease Control and the Hawai'i Department of Health websites, but Brauherr credits Martell with saving his life.

Hilo Medical Center, which has handled at least 80 identified cases of the disease, has been treating some severe cases such as Brauherr’s with a combination of a steroid, Prednisone, and a second drug called Albendazole, which is designed to kill the worms.

"The DOH and CDC are "essentially using outdated information," says Martell: "I just don’t think that they represent the state of the art on this or even the authorities. This Rat Lungworm Disease is treated in China and Southeast Asia all the time. Australia has been very aggressive with the use of Albendazole."

Dr. Jon Martell of Hilo Medical Center thinks the federal and state approaches to rat lungworm do not represent the state of the art.

Saying that many victims don't need treatment because eventually the worms die off on their own is misleading. He says even if the worms eventually die on their own - the longer you leave them in the body, the more damage they can do. The developing worms burrow through organs and often end up in the brain, where they develop, he says, into "sub-adult adolescent worms".

"When they are sub-adults they want to get out of your brain and back into your bloodstream where they can party and make baby worms and they can do a considerable amount of damage trying to break out. In my mind that makes a pretty convincing case for doing some type of treatment with an anti-parasitic if you can."

"We know certain anti-parasitics are safe to use in humans," Martell says.

"Albendazole is proven to be safe in humans, and it is proven to be effective for other worm diseases in humans, including some in the brain. In addition, we know that Albendazole, given to mice that are infected with rat lungworm, does decrease the number of worms … there’s no reason to believe that it would not have the same effect in humans."

Martell maintains that the studies that don't show effectiveness of antiparasite drugs in treating rat lungworm disease are flawed because they do not have enough test subjects and they do not distinguish mild cases from moderate and severe ones.

"Our experience in Hilo Medical Center is that we have a significant number of patients with moderate and severe disease and we have been able to use Albendazole safely and effectively in this population," he says.

"When we approach our patients who are in this condition, we have a protocol to determine if they have mild disease, moderate disease or severe disease, and we treat them based on the severity of the disease and our experience in treating patients who are afflicted with rat lungworm."

Brauherr, who it seems was obviously losing his fight with the disease when he checked into the hospital, had little to lose by trying the anti-worm drug. Even with the drug's help, if it is what helped, he is still left with the damage done by the disease.

When he awoke from his coma, he had to re-learn basic skills like walking and even swallowing, because of the damage the worms had done to his nervous system. He still has trouble with everyday tasks such as driving.

"I probably won’t be able to do physical stuff like running or biking again,” says Brauherr.

And it appears that he has fought his last fire.



Jack Russell Brauher
Hawaiian Acres Mountain View, Hawaii
pulama11@live.com


MY RLW STORY (And, what I’ve learned about an insidious Parasite)
Source of Infection? Unknown, but several possibilities.

November and December 2016, I ate locally grown salads at 2 different restaurants. Waimea and Kailua-Kona. But, I did also have my own garden produce. The story, of my experience with RLW would not be a story without the Cause and Effects that lead up to it. I don’t expect my story, to be of any or much interest to most readers. But, its my Story. And, personally, to continue my survival, I'm the only one that needs to process what happened.

In perspective, or retrospect, its really a chapter. I really cringe to hear it called a disease as I have a different mindset. A different observation.

This is a Parasite. It escaped its symbiotic loop with the rat and slug. Its too early to say with any certainty, this human interaction, is not a evolutionary adaptation, or experimental Trial and Error, of the angiostrongylus cantonensis or parmarion martensi species.

LIFE BEFORE RLW

So, where, did it begin? There's not just a back story - there's a deep story!
Deep into the past of my life.
It was my high school graduation year - 1971.

Born and raised in the rural environ of SE Michigan, 30 miles NW of Detroit, was a great life - I was the oldest of 5 kids. With no real direction, no goals. I was just starting to question my existence. I was dabbling in all the trappings of a teenager in a modern world. Discovery, adventure, cars, girls, parties, new friends. abundant music concerts, etc.

But also, advanced learning, reading, gardening, bird watching, hunting, fishing, canoeing, philosophy/metaphysics and natural science.

Then there was alternative foods, alternative housing, alternative thinking - Life was full of mystery and wonder! Like Joni Mitchell’s Circle Game! What did my path have in store? In retrospect, What did it matter? Time was in abundance!

Right out of High School, I began a great job, for a young man, in a wholesale lumberyard. I worked long hours, and saved my $. By 18 years of age in 1972, on my own, I was able to buy my first new truck. I had to wait for the factory to build it. Shortly after, I picked up a magazine at a local bookstore, that unbeknownst to me, was to set my course of life. Mother Earth News (MEN), opened up the door.

Immediately, I started organic gardening on my parents land, in SE Michigan. It was amazing! I could grow my own food! Who’d of thought such was possible, when so young.

In the back section of the monthly M.E.N., were all the advertisements. classified’s, DIY's, etc. One Ad for DYI books captivated me - solar, wind, gardening, alternative homes, etc. I mail ordered a bunch of DYI books. My goal now, was to get to the land, and live off it.

In 1974 I turned 21. Environmental awareness began to grip my consciousness. Ozone depletion was the buzz! From that time on, I've lived as low impact as possible, on the Planet.

By 21 years of age, in 1975, I had saved enough to buy my first home. (Let the work begin!) I remodeled, repaired, and increased the value. I rented rooms, and paid off my land contract.

1977, Hawaii entered my head space. I had read about a previously unknown new species of bird discovered on Maui. The Po’O Uli. My brother Mike, had just landed here. He was telling the family about the tropical paradise life.

1978 I made my first trip here in December - went deep sea fishing on a Kona Charter, stayed in Volcano, Waikiki, and Hawaiian Acres. I got to see, firsthand, the rainforest and I was hooked!

1979, Mike and I bought 6 Acres, in Hawaiian Acres for $10K. I put my Michigan house up for sale and in 1980, I quit my lumber yard truck driving job.

Somehow I was to get to the Big Island? I moved to Phoenix, AZ, thinking it was getting me closer. And to escape the brutal Michigan cold.

1983, I finally landed in Hilo. Ready for the tropical life! Puu Oo was going full blast! Gardening was my first passion here. I grew lots of new veggies and fruits, with success. The weeds and pests were unlike anything I’d been accustomed to - aphids, grasshoppers, and slugs! Not one of them was a problem to adapt to.

1985, I bought a boat and took up commercial fishing. 13 restaurants and 2 grocery stores, were my main customers. Peddling fish on the roadside was inevitable.

Over the following years, I covered my land with various fruit trees. The garden and its variety of options, was expanded upon and I took up rabbit breeding, and Muscovy ducks.

I was now considered an organic farmer. Even though it was mostly sustenance. As a livestock farmer, rats were always a force to deal with, and to control.

1989 I started a career of Security Technology, that would last over 30 years. 1991, I became a Captain on HA's first Volunteer Fire Dept. Then took up community politics, as president of one of the worlds largest subdivisions community associations. I proceeded to write the first History of HA, and my 1st Master Plan.

In 2002, I designed and built an off grid alternative modern custom farm dwelling. By 2006, I had left community politics. (How stupid was I, to think landowners could agree to a mutual and cohesive direction?)

In 2010, I bought my 2nd deep sea fishing boat. Yes! I was hooked!

And, this was the first year RLW came into my life! I just didn’t know it yet.

Cleo, my Australian Shepard had succumbed to it. Her repeated visits to the Vets, stumped them repeatedly. Her last xrays, displayed her internal organs and they were permeated completely with tiny spotted scars. This is the, now known, signs of Parasitic Nematodes. She was a prolific ratter!

FIRST (personal) CONTACT WITH RLW

Tropical gardening has been a vital component of my alternative lifestyle. I’ve always been vigilant on preparation of my produce, before consuming. When you’re Organic, your already vigilant. December 31st 2016, was my first symptom. I was visiting Phoenix Az. when I noticed a metallic taste to whatever I put in my mouth.

The next day January 1st, 2017, I got the chills that lasted all day. On January 2nd, I was flying back home to Hawaii and started my beginning to what was thought to be the Flu.

I went to my primary care provider 3 times for these symptoms, in January of 2017. They turned me around each time, stating there was no course of action to take, unless I actually broke out with the flu - which I never did.

Also, in early January of 2017, I’d had a dental appointment that had appeared to have left me with severe pain in my right jaw. This was likely symptoms of RLW? Especially considering I still have these pains 2.5 years out.

10 days into February of 2017 I was sleeping all day and skipping work. After 3 days of that, my brother, Mike, took me into HMC on February 13th, but I don’t recall a single moment of it. I was in a delirium stage.

They sent me home with medication and observation overnight. I went from bad to worse.

THIS IS HOW I FOUND OUT I HAD RLW and HOW I WAS DIAGNOSED

Actually, not really. It took about a week long semi comatose state, before I could even begin to comprehend, why I was hospitalized. In this hospitalization, I recall to this day, the psychoactive effects of the medications. Dreams! Some were out there, some were PURE HELL. I truly experience flashbacks, of these.

I didn’t even know about the spinal puncture until 2 weeks after the fact. I was case number 2 for DOH records, of 2017. (there were 18 total) At the time of my diagnosis, the suspected and known incubation was reported to be 7-10 days before symptoms.

I had fought the first effects for about 6 weeks. Back tracking, and knowing I’d used 2 big island restaurants in November and December of 2016 - I then suspected them. One in particular, had a very bad tasting salad. The other restaurant, is where my dining partner claimed to have had a mystery illness for weeks afterwards.

My best assets in this, were my brother living next door, and my excellent health going in.

LONG TERM EFFECTS

To this day, I still have the Right Jaw paralysis and pain. The 6th Nerve Palsy dissipated within the first 2 weeks out of HMC. I initially had minor left leg pain. That became more severe as time crawled on.

In May of 2017, I was in San Diego when I realized my left ankle was swollen, so I went Urgent Care in El Cajon. They sent me to Sharp Grossmont Hospital for ultrasounds. They confirmed a blood clot in my left ankle. My research into blood clots, indicated mine was possibly due to the spinal puncture?

This left leg nerve pain continues to dog me, and is probably the biggest detriment to my quality of life. It caused depression at first, then became great disappointment. Pre RLW I was a runner in organized BI events. I did well, and placed in the top on most runs. My long distance bicycling appears to have ended, as well.

The Neurology Dept at HMC gives me hope these nerves will regenerate. I still to this day, 2.5 years out, get severe leg cramps, after even moderate exercise and one long-term effect that lingers, is weight loss.

At 1st contact, my weight hovered with regularity, at about 192 lbs. In the hospital, I dropped to about 151lbs, at one point. In recovery, I gradually put the weight back on.

At first, I went back up to about 185lbs, but after the adjustments in dietary habits, I now regularly weight in at 171 lbs. I feel great at that number. But, I wouldn’t recommend RLW as a weight loss program!

Some of this could be related to the difference in muscle density. With less endurance exercise in my life, it makes sense. All in all, even should I never regain my previous life, I’m grateful to HMC’s awesome quality of care. I have hope! I am lucky to be a survivor. Another long-term effect, is the abandonment of my gardening.

Going forward, my fruit trees will get the preferential priority. Freezing and cooking is like a stuck record playing in my head. I can’t get it out of my head!

This is not an oxymoron, but my cognitive skills were actually rather quick to return.

MEDICATIONS

I’m an all natural kinda guy. No pain management for this man. Pain is confirmation of living, to some degree. I’ve seen to many deaths from pain management meds, gone awry.

My life’s guiding philosophy is, No Pain No Gain/ If It Doesn’t Kill You, It makes You Stronger! / No Guts, No Glory! / No Wounds, No Story!

I do enhance normal nutrition with vitamins and limited supplements. Magnesium oxide has been suggested for nerve pain, I do use it.

HOW DO I COPE

Staying as active as possible, gives the best results - Weight lifting, push ups, stretching (some call it Yoga), reading, poetry, music, birding, photography, woodworking, art, yard work, are some of my main activities, that keep me focused on my healing.

Cooking has been the biggest activity since RLW. I plan out every meal, elaborate or simple. Fishing, is probably my greatest life passion which has not waned.

Being involved in RLW awareness, helps me cope. I don’t really feel stress is an issue. I’m pretty independent, and have enough hobbies and fur friends to keep me busy.

One way I cope with this, is my regular night patrol around my home, with a container of granulated salt. This is not a perverse vindictive response to Slugs. NO! - It’s exactly such. Its satisfying beyond comprehension. And, they are almost impossible to find anymore. I’ve upped my cat Family from 2 to 4. Rats, show almost no signs of inhabitation here. Occasionally, I see signs around, or in, the avocado trees.

GOALS

Simply put, is to return to the sporting exercise based life I had before RLW. I don’t mind trading in my previous food preferences, for the healthy cooking life! Its actually quite promising!

Another goal is to see others stop calling it a disease - Its a PARASITE! Sure, there are side effects. But, its still a PARASITE!

It’s also a goal to get Hawaii State Agriculture and Tourism to up their game on the incoming flights AG forms. There needs to be, with no uncertainty, adequate warnings to tourists.

COMMUNITY

I share my RLW horror with anyone that is interested. My new community, is the RLW Survivors. If I can educate one person that educates another, that tells another and spreads the knowledge, etc, then I’ve helped the greater community!

Another community benefit from this, is the awareness that our canine family benefits from the regular worming medications, that controls intestinal parasites.

HEALTHCARE PROVIDERS

Outside of my experience with my Primary Care Provider (PCP), I feel this group is the least of any concerns, anyone should have. They are the FrontLine (HMC), and do a great service.

LEGISLATORS

They need to extract they’re heads from the PROVERBIAL sand. Firsthand experienceis the one thing that can wake them up! But, then I don’t wish such on them?

NEW RLW VICTIMS

My Advice, as a survivor! The healthier you are, going in, the quicker the recovery. I feel it was to my benefit. Assuming, that is that treatment was obtained quickly - Stay the course! It may not be quick, but recovery is imminent.

IF IT DOESN’T KILL YOU, IT’LL MAKE YOU STRONGER!

Skip the pain management drugs! NO WOUNDS, NO STORY! And, drag your fFeet, to slow the circles down! Life is short! RLW took me to deaths door. I sincerely felt my hand on that door and I refused to go through it! - Too many things to do!

ADDITIONAL ADVICE?

You’ll have to sort it out of the above story!

FOLLOW UP NOTE; I have 4 dogs. One, my border collie Xena is the Ultimate Rat Patrol. She checks consistently and regularly, the known areas where Rats were seen. I've seen her swallow them whole! Yes! That’s right! Whole! Even though the rat population is at all time low, I keep up the worming meds for all 4 dogs. The round worm parasites are kept in check.


This information is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the parasites described above or think that you may have a parasitic infection, consult a health care provider.

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