Jayden Lugo has had 56 surgeries in her short life.
The 10-year-old from Wasco in the Central Valley has brain damage, uses a walker to get around, undergoes therapy once a week and takes three pills every night before she goes to bed.
Jayden was born healthy but she contracted coccidioidomycosis, or valley fever, becoming one of an estimated 150,000 adults and children a year who get the disease, prevalent in California and Arizona.
What happened next illustrates the impact valley fever can have when it is not diagnosed early enough.
"A simple blood test would have prevented all of these. That's what makes us so mad," said her mother, Jillian Lugo. "She would have been a totally different kid."
That blood test is just part of the problem. Public awareness of the signs and symptoms of valley fever is low nationally, even in the Southwest where it is common.
Doctors too often diagnose influenza or a bacterial infection. They don't think of valley fever until the disease has progressed and the patient is very sick. Although a blood test would have caught Jayden's valley fever earlier, even the available tests are inadequate because they take too long to produce results.
Public doesn't recognize disease
Jayden was 2 months old in October 2002 when her breathing became labored, she developed a bad cough and her temperature started to rise. Her parents thought she was coming down with the flu or a cold.
"Being at that age, I thought that this was basically her first time getting sick," her mother said. So the family didn't worry.
Jillian Lugo's response is common. When valley fever strikes, most people fight it off without even developing symptoms. So many people are exposed to the fungal spores in California that even in the coastal areas where there are relatively few cases, experts estimate that millions of people are infected.
Dr. Steven Larson, a Riverside infectious disease specialist and member of the California Medical Association's executive committee, said widespread exposure has been documented using skin tests, even in areas outside of the Central Valley, the valley fever hot spot.
This means, for example, "probably more than one-half of the population of Orange County that's lived there more than 10 years will have acquired antibodies to this infection," Larson said.
If people do get sick, the symptoms often mimic those of other common illnesses such as a cold or the flu.
Public health departments in California do not include valley fever as part of regular awareness campaigns, like that of the influenza virus. The disease doesn't generate intense media coverage either, unlike the recent outbreak of fungal meningitis. People don't think to ask their doctors to test for the disease.
When Jayden came down with flulike symptoms, the state was in the middle of a spike in valley fever cases unlike anything seen in a decade. In 2000, there were 860 people officially diagnosed with the disease statewide. By 2002, the number had more than doubled -- to 1,727.
But state and federal public health officials did not issue any warnings about the disease.
The rise in cases wasn't even mentioned in the news media, according to media databases. Jayden's parents say they had heard of valley fever when doctors finally diagnosed it in their daughter, but they didn't know much about it.
If someone lives in an area where valley fever is common or has recently traveled there and he or she suffers from cold or flu symptoms that persist for more than a week, the person should visit a doctor and ask about the possibility of a fungal infection, said Dr. David Stevens, a Stanford scientist who has worked on valley fever-related studies since the early 1970s.