Ron and Darlene Fields pose during their 2016 trip to Hawaii — before Ron got sick. Photo courtesy of Darlene Fields

Ron and Darlene Fields had been married for 26 years when they decided to take a “free” 12-day trip to Hawaii in fall 2016.

Ron was 62 then, and his construction business in Sarasota, FL, was really taking off. Darlene, who does paperwork for the company, had saved up credit card reward points so they could fly to Los Angeles, spend a night there and then fly to Maui for five nights before moving on to the Big Island.

The only things they expected to pay for were food and an excursion from one side of the Big Island to the other.

The Fieldses, physically fit and devoted for the past dozen years to eating organically, were a couple of days away from heading home when Ron got sick.

“My husband woke up in the middle of the night and couldn’t quite describe what was going on with his skin,” Darlene said during a telephone interview from their Florida home. “It was worse in L.A., and more when we got home. … We arrived home on a Saturday and by Thursday, he laid down in the bed — and he couldn’t get up for months.

“He called it burning skin pain. Then he started to have bladder problems and couldn’t urinate.”

Ron and Darlene Fields would end up taking a journey longer than any they’d imagined when they booked their flight to Hawaii.

Along the way, they’d go to emergency rooms, a hospital in Gainesville, FL, and an integrated health center. They’d see neurologists and urologists, general practitioners and meningitis specialists, medical marijuana consultants and acupuncturists and hypnotists.

The cause
The likely culprit behind it all: a tiny slug hiding in one of the many salads the couple ate during their trip.

The slug likely was home to a disgusting little parasite called rat lungworm that is carried in rat feces, which slugs and snails eat. The slugs and snails serve as intermediate hosts for the rat lungworms, which can’t mature or reproduce in humans but can cause a host of physical problems including eosinophilic meningitis and ocular Angiostrongylus if people ingest them.

The semi-slug, officially known as Parmarion martensi, is shown here on a nickel for scale. Photo courtesy of the Hawaii Department of Health

Rat lungworm infections typically come from eating raw or undercooked snails — or slugs — that can be in lettuce or other raw produce that hasn’t been washed thoroughly and/or cooked throughly. It has been endemic in Hawaii for at least the past 50 years, according to public health records.

Ron and Darlene Fields didn’t eat any snails, so they’re pretty sure Ron contracted the infection from a salad, which they ate every day of their vacation.

“You know, a Caesar salad or whatever they had in the restaurants,” Ron said in recent days.

Experts say early symptoms of rat lungworm infection can include headaches, neck stiffness, nausea and vomiting and that the illness might incubate for a single day or for as long as six weeks before symptoms appear. Infected people are not contagious. Recovery time varies in many cases from a couple of weeks to a couple of months.

Not so in the case of Ron Fields.

“We would go to the emergency room and to our family doctor. We tried acupuncture for the pain,” Darlene said. “During the couple of weeks after we arrived home, I could get him in the car and get him to the emergency room, but when he was home, he just lay in bed, too weak to walk, and any jostle in the car just caused excruciating pain.”

How they discovered the cause
A couple of weeks into the whole thing, Darlene’s mom was flipping through the TV channels one day and caught the words “Big Island” and “rat lungworm” on the Animal Planet network. That sent Darlene on an internet search that led them to the answer.

Rat lungworm disease is reported in about 30 countries in Asia, Africa and Caribbean and Pacific Islands. In Hawaii 80 percent of land snails carry the parasite, which has caused two deaths in the islands since 2007. The state typically experiences one to nine rat lungworm cases a year.

In 2017, however, the Hawaii Department of Health recorded 18 laboratory-confirmed cases, said Anna Koethe of the department’s communications office.

The life cycle of the rat lungworm parasite, as depicted by the Hawaii Department of Health.

Ron Fields’ case is one of an unknown number not included in the public count because his illness, like other people who get sick after returning home, wasn’t reported to Hawaiian public health authorities.

In fact, despite dozens – if not hundreds – of medical tests, doctor visits and exams, Ron never got confirmation that he was infected by rat lungworm disease.

“We were confident of what it was, but they wanted to do another spinal tap to take more fluid, and my wife said no,” he said.

“It was confirmed that it was a parasitic form of meningitis, though.”

During all of their efforts to get a diagnosis and help, they encountered no one in Florida who had heard of the condition.

”They diagnosed all these silly things,” said Darlene. “We thought he was dying, and they said acid reflux, stress. It was just weird. Even after we found out what it was and told doctors, nobody had ever heard of it.

“We diagnosed it ourselves from the internet. I called the Big Island, the hospital, the CDC, I think, trying to get hold of a doctor who had treated it to see what we could do. … I finally called an emergency room in Honolulu and got a doctor who said it was  untreatable but it would go away eventually.

“I said, ‘How long?’ and she said, ‘A long, long time.’ She said, ‘months,’ and I said, ‘He won’t make it months.’ ”

In the end, Ron Fields spent 10 months with a catheter because he couldn’t urinate. He spent nine days he doesn’t remember in the Gainesville hospital. He had IV treatments of vitamin C and he had problems with his bowels. He developed meningitis and had to have a spinal tap.

The time in Gainesville was a nightmare, Darlene said.

“All I did was tell my story every day, all day long,” she said. “Students, neurologists, doctors – and nobody knew anything. They were giving him a lot of antibiotics … trying to eliminate kinds of meninigitis.

“There was nothing to do to help him. He was losing weight. He was getting weaker and sicker instead of better. We went home after nine days and between October 2016 and January or February 2017, he determined he was never going to get better.”

Ron Fields is thankful that he is able to get out of bed, work some days, and spend time with family. Photo courtesy of Darlene Fields

Good days and bad days
Ron is 64 now, and, most days, he goes to work but does less physical labor. He’s lost weight and agility.

“I don’t know if words can really describe (it),” he said. “It’s been challenging. As far as my balance and ability to be able to work every day without disability is about 90 percent.

“It took a while to get there. I still suffer from the neuropathy from the nerve damage that happened to me, and it’s just been a real struggle with that.”

Said Darlene: “Now, every morning he has to go through agony just to get his shirt on. It hurts so badly.”

Ron had to kick morphine, which doctors had him on for three or four months for the pain. He takes a nerve pain medication, but the Fields worry that it’s not good for him long-term. So, he uses medical marijuana, which has been legal in Florida since 2016.

The marijuana, which he uses in vaping form, makes life tolerable.

“We’re so thankful that medical marijuana is legal in Florida,” said Darlene, adding that it helps her husband sleep.

It doesn’t get him high.

“He doesn’t act drunk or high or anything but he’s not able to think as clearly,” she said.

“I thought it was wrong before,” she said of marijuana use. “But a neurologist recommended it and as a Christian he explained how he used to feel the same way, but as soon as we realized how many people it helped … it doesn’t bother us at all.

“Being able to sleep now is a big boost,” Darlene said.

The Fieldses have a type of alternative health insurance through Christian Healthcare Ministries for major medical expenses, but a lot of the treatment and pain relief they tried wasn’t covered.

It’s been challenging, Ron Fields said, but they’ve had help.

“I am a Christian, and if it wasn’t for the love of Jesus Christ and the relationship I have with him to give me the strength, I would never have made it.

“I have good days and I have bad days.”

Ron said he doesn’t rule out a return to Hawaii, but both he and his wife say they’d do things differently – no salads, and probably not even fruit or fruit juice.

“It’s changed our lives,” Darlene said. “We’ve lost hundreds of thousands of dollars. His business was really starting to thrive … and when we came back, he just couldn’t work.”

They considered seeking compensation through a lawsuit but since they don’t know where Ron picked up the parasite, there’s really no one to sue.

“We don’t want to sue,” she said. “That’s not the point. What bothered us is that nobody knew about it. We wouldn’t have gone to Hawaii in the first place, and we certainly wouldn’t have eaten like we did.

“We went to Hawaii because I always love to find ways to travel for free … I tell everybody it was the most expensive free trip ever.”

Public health action
The Hawaii Department of Health launched a statewide public education campaign to raise awareness and inform people about best practices they can implement into their daily routines to prevent the spread of rat lungworm disease.

The first initiative, launched late in 2017, included a statewide broadcast media component through a partnership with the Hawaii Association of Broadcasters.

The campaign consists of three radio and three television commercials currently airing on 40 radio stations and seven television stations through the end of June 2018.

The department also has large-scale graphic advertisements displayed in malls and shopping centers across the state. It’s educational materials include rack cards, door hangers and posters that are being distributed during community events and health fairs.

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