A MICROSCOPIC PARASITE WITH POTENTIALLY DEVASTATING CONSEQUENCES.

RAT LUNGWORM DISEASE CONTINUES TO BE HIDDEN THREAT IN HAWAII.

NOW NEW RESEARCH FINDS THAT THIS PARASITE MAY BE HIDING IN MORE THAN JUST YOUR PRODUCE.

FROM DIAGNONSIS, TO TREATMENT, TO PREVENTION WHAT THE EXPERTS HAVE TO SAY, PLUS A SURVIVOR SHARES HER EXPERIENCE AND HER ONGOING RECOVERY.

TONIGHT’S LIVE BROADCAST AND LIVE STREAM OF INSIGHTS ON PBS HAWAII START NOW.

¶¶ ¶¶ ¶¶ >>Yunji: ALOOOOHA!

AND WELCOME TO INSIGHTS ON PBS HAWAII.

I’M YUNJI DE NIES.

IT’S A GROWING CONCERN FOR THE ISLANDS IN RECENT YEARS, RAT LUNGWORM DISEASE.

THIS EVENING ON INSIGHTS, WE’LL BE TALKING TO THE EXPERTS ABOUT WHAT THIS DISEASE IS, HOW IT’S SPREAD AND HOW YOU CAN PROTECT YOURSELF.

WE LOOK FORWARD TO YOUR PARTICIPATION IN TONIGHT'S SHOW.

YOU CAN EMAIL US OR CALL US WITH YOUR QUESTIONS.

WE ALSO ENCOURAGE YOU TO GET INVOLVED WITH THE CONVERSATION ON OUR FACEBOOK PAGE.

NOW, TO OUR GUESTS, DR.

ROB COWIE IS A RESEARCH PROFESSOR AT UH MANOA’S PACIFIC BIOSCIENCES RESEARCH CENTER.

HIS EXPERTISE IN SNAIL SPECIES LED TO HIS RESEARCH INTO RAT LUNGWORM DISEASE.

SO FAR, HE’S PUBLISHED SOME 30 ACADEMIC RESEARCH PAPERS ON THE DISEASE…INCLUDING ONE JUST DAYS AGO, AND HE’LL BE SHARING THAT WITH US TONIGHT.

DR. KIANA FRANK IS ALSO WITH UH MANOA’S PACIFIC BIOSCIENCES RESEARCH CENTER WHERE SHE IS AN ASSISTANT PROFESSOR STUDYING THE IMPACT OF MICROBES IN NATIVE ECOSYSTEMS.

SHE ALSO BRINGS A UNIQUE VOICE TO TONIGHT’S PANEL BECAUSE SHE IS RECOVERING FROM RAT LUNGWORM DISEASE.

DR. VERNON ANSDELL IS AN ASSOCIATE PROFESSOR AT THE UNIVERSITY OF HAWAII JOHN A. BURNS SCHOOL OF MEDICINE.

HE’S A SPECIALIST IN TRAVEL AND TROPICAL MEDICINE AND RECENTLY HELPED DEVELOP UPDATED GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF THE DISEASE.

JOE ELM IS WITH THE HAWAII STATE DEPARTMENT OF HEALTH’S COMMUNICABLE DISEASE DIVISION.

HE IS THE SUPERVISOR FOR THE FIELD INVESTIGATIONS SECTION OF THE DISEASE INVESTIGATION BRANCH.

THE DISEASE INVESTIGATION BRANCH IS RESPONSIBLE FOR MORE THAN 64 REPORTABLE DISEASES AND CONDITIONS.

THANK YOU FOR BEING HERE TONIGHT.

WE APPRECIATE IT.

TELL US THE BASICS WHAT IS RAT LUNGWORM DISEASE?

>> RAT LUNGWORM DISEASE IS A DISEASE CAUSED BY PARASITE SCIENTIFICALLY KNOWN AS ANGIOSRONGYLIASIS.

PARASITE NATURAL LIFE CYCLE OF THE PARASITE GOES THROUGH RAT AND RAT LUNGWORM, AND SNAILS.

THE WAY IT WORKS BRIEFLY IS THAT THE ADULTS REPRODUCE IN THE RAT.

IN ITS PULMONARY SYSTEM.

PULMONARY ARTERY IS LEADING TO THE LUNGS.

THEY LAY, MATE.

FEMALES LAY EGGS.

THERE'S EGGS TRAVEL THROUGH THE PULMONARY ARTERY TO THE LUNGS WHERE THEY HATCH INTO FIRST STAGE JUVENILE WORMS LARVAE.

COUGHED UP THE WINDPIPE AND GO DOWN THE GUT, AND HAVE THE OTHER END OF THE RAT IN THE RAT'S POOP.

THEY'RE SITTING IN THE POOP, SNAIL OR SLUG COMES BACK ALONG.

AND EATS THAT POOP.

AND INGESTS FIRST DAY STAGE LARVAE DEVELOP IN THE SNAIL OR SLUG.

LET ME FROM NOW ON SAY SNAILS.

SIMPLER.

LARVAE DEVELOP THROUGH TO THESECOND STAGE.

THEN TO THE THIRD STAGE.

IN THE SNAIL.

THAT THIRD STAGE IS THE INFECTIOUS STAGE OF THE PARASITE.

THAT JUST SITS THERE IN THE SNAIL, JUST HANGING OUT.

UNTIL RAT COMES BACK ALONG AND EATS THAT SNAIL.

INGESTS THOSE THIRD STAGE LARVAE WITH THE SNAIL, THOSE THIRD STAGE LARVAE GO DO DOWN THE RAT'S GUT.

WORK THEIR WAY THROUGH DIFFERENT ORGAN SYSTEMS IN THE CIRCULATION SYSTEM TO THE RAT'S BRAIN FROM THERE, DEVELOP FROM THE FIRST STAGE.

RAT'S JUST INGESTED TO THE FOURTH STAGE AND THEN FIFTH STAGE WHICH IS THE SUBADULT STAGE.

THOSE SUBADULTS LEAVE THE BRAIN.

AND GO DOWN TO THE PULMONARY SYSTEM FOR THE PULMONARY ARTERY.

GROW, REPRODUCE, CYCLE GOES ROUND AND ROUND.

INSTEAD OF A RAT EATING SNAIL HAS INFECTIOUS THIRD STAGE LARVAE.

PERSON COMES ALONG AND EATS THAT.

ON A DARE SOMETIMES.

THEY'LL EAT THAT SNAIL.

DELIBERATELY OR ACCIDENTALLY AND SAME THING HAPPENS.

AS IT DOES IN THE RAT.

THE FIRST DAY STAGE LARVAE INGESTED, GO DOWN THE GUT.

EVENTUALLY REACH THE BRAIN.

MATURE TO THE FOURTH AND FIFTH STAGES BUT IN DIFFERENT FROM READ SPREADINGS.

CAN'T GET OUT.

WE DON'T UNDERSTAND WHY THEY DON'T GET OUT.

THEY DIE IN YOUR BRAIN.

AND IT'S THE MOVEMENTS OF THE WORMS FEED AND GROWING IN YOUR BRAIN AND THEN DEATH OF THE WORMS, WHICH CAUSES HEIGHT ENDED REACTION, INFLAMMATION, THAT IS WHAT CAUSES THE SYMPTOMS OF THE ILLNESS THAT WE KNOW AS RAT LUNGWORM DISEASE.

>>Yunji: LET'S BRING NEW ON THIS.

TALK ABOUT WHAT YOU SEE IN PATIENTS, HOW IT IS ACTUALLY EXPRESSED.

WHEN THOSE ARE IN YOUR BRAIN.

WHAT HE'S TALKING ABOUT THERE AND HOW THIS IS DIAGNOSED.

>> DISEASE PRESENTS IN A WIDE VARIETY OF WAYS.

THAT'S WHAT MAKES IT SO DIFFICULT FOR MEDICAL PERSONNEL TO MAKE THE DIAGNOSIS.

SYMPTOMS OCCUR AFTER THE SNAIL HAS BEEN SWALLOWED.

GETS ABSORBED FROM THE GUT.

SPREADS THROUGH THE LIVER, HEART, LUNGS, TRYING TO GET TO THE BRAIN, YOU GET A WHOLE CONSTELLATION OF SYMPTOMS VERY CONFUSING.

IT DOESN'T GET ANY EASIER ONCE IT GETS TO BRAIN BECAUSE THESE LARVAE, THESE WORMS, MY GREAT AROUND THE BRAIN CAUSING ALL SORTS OF DIFFERENT SYMPTOMS.

SO PATIENTS PRESENT IN VERY STRANGE WAYS.

IT CAN BE VERY CONFUSING.

>>Yunji: DR. FRANK, I WANT TO BRING YOU IN ON THIS.

YOU EXPERIENCED THIS FIRSTHAND.

DR. FRANK.

TELL US ABOUT HOW YOU FIRST BELIEVED THAT YOU CAN CONTRACTED PARASITE AND WHAT HAPPENED?

>> I HONESTLY HAD NO IDEA I CONTRACTED RAT LUNGWORM DISEASE.

I PRESENTED VERY DIFFERENTLY.

JUST NOT SURPRISING TO ME.

ALWAYS LIKE TO BE DIFFERENT.

I STARTED ON THE WITH A BIG INFLAMMATORY RESPONSE.

I THOUGHT I WAS HAVING ALLERGIC REACTION.

I WAS SO ITCHY, I HAD DEVELOPED BUMPS ALL OVER MY BODY.

I'M ALLERGIC TO A LOT OF THINGS.

IT'S PRETTY COMMON.

I CALLED MY DOC.

IMMEDIATELY PRESCRIBED PREDNISONE.

HONESTLY, I THINK PROBABLY WHAT SAVED MY LIFE.

BEING PRESCRIBED PREDNISONE SO EARLY IN THAT PROCESS.

AS SOON AS I GOT ON THE MEDICATION SYMPTOMS STARTED TO CHANGE, I THEN GOT A REALLY HIGH FEVER.

I DIDN'T KNOW QUITE WHAT MY BODY WAS EXPERIENCING I JUST STARTED HAVING THESE REALLY INTENSE PAINS.

IT FELT LIKE I WAS BEING ELECTROCUTED OR LIKE LIGHTENING WAS STRIKING ME OR THAT I SUDDENLY GAIN MAGICAL POWERS BUT COULDN'T EXPRESS THE MAGIC OUT OF MY BODY.

AND I DON'T REALLY LIKE DOCTORS.

DON'T WANT ONE.

MEDICAL.

I STRUGGLE WITH THOSE LAYERS.

AND SO I DIDN'T WANT TO GO TO THE HOSPITAL.

HUSBAND AND I ACTUALLY HAD A DEAL THAT IF MY FEVER HIT OVER 103 WE HAD TO GO TO THE E.R.

BY THAT TIME, I COULDN'T EVEN WALK.

HE HAD TO BASICALLY CARRY ME, KICKING, SCREAMING, BECAUSE I WAS IN SO MUCH PAIN.

WENT TO THE ER.

AND THEY HAD NO IDEA WHAT WAS WRONG WITH ME.

THEY ACTUALLY, DID SOME SCANS.

THEY SENT ME HOME.

THOUGHT I WOULD BE FINE.

AND THEN AS SOON AS WE GOT HOME, YOU KNOW, ABOUT COUPLE HOURS LATER, THEY CALLED AND SAID, YOU HAVE TO COME BACK.

THEY THOUGHT I HAD BACTERIAL INFECTION IN MY BLOOD.

HIGH FEVER.

PRESENTED WITH ALL OF THESE SYMPTOMS.

AND SO THEY STARTED TREATING ME WITH BROAD SPECTRUM ANTIBIOTICS WHICH YEAH, SURE.

BROAD SPECTRUM ANTIBIOTICS.

EXCEPT THE PAIN ONLY KEPT GETTING WORSE AND WORSE.

I FOUND OUT I WAS ALLERGIC TO MORPHINE.

SO THAT DIDN'T MAKE PAIN MANAGEMENT ANY SIMPLER.

IT WAS 17 DAYS IN THE HOSPITAL UNTIL THE DOCS HAD ANY CLUE.

UNTIL THEY DID A SPINAL TAP, AND GOT MY FLUIDS AND SAW ELEVATED WHITE BLOOD CELL THAT REALLY INDICATES PARASITIC INFECTION.

ONE OF THE ONLY ONES HERE IN WHO I WOULD BE RAT LUNGWORM.

SO I HADN'T BEEN ON ANY ALBENDAZOLE.

KEPT ME ON PREDNISONE.

ONLY TYPE OF PAIN I HAD WAS TYLENOL.

I JUST, YOU KNOW I JUST REALLY WANT TO SAY I'M SO GRATEFUL FOR MY NURSES TOOK CARE OF ME DURING COVID.

WHEN I WAS BY MYSELF, I WAS AFRAID I WAS IN SO MUCH PAIN, THAT LIKE EVEN A HAIR OR TOUCH, IT FELT LIKE I WAS ON FIRE.

I WAS CONSTANTLY BEING ELECTROCUTED.

I DON'T THINK I SLEPT IN WEEKS AND WEEKS.

IT WAS A VERY HARD EXPERIENCE AND THEN WHEN WE FINALLY GOT A DIAGNOSIS, I REMEMBER MY DOCTOR WHO WAS JUST THE MOST AMAZING MAN EVER, HE CAME IN AND HE SAID, WE THINK YOU HAVE RAT LUNGWORM.

I THINK I LAUGHED AT HIM, ROB ASKING ME FOR YEARS TO STUDY RAT LUNGWORM WITH HIM.

ALWAYS SAID NO.

THIS WAS A SIGN FROM THE UNIVERSE.

AT THAT POINT, I WAS SO EXCITED TO HAVE A DIAGNOSIS.

AND THEY IMMEDIATELY PUT ME ON ALBENDAZOLE.

BY THAT TIME, WHO KNOWS IF THAT EVEN DID ANYTHING.

THE LAYERS OF THE PARASITE IN MY BODY MAY HAVE ALREADY BEEN DEAD.

WHAT THEY DID DO BECAUSE MY PAIN WAS SO EXTREME, AND I DIDN'T TOLERATE A LOT OF PAIN MEDS VERY WELL,ER END UNDER DOING EXPERIMENTAL TREATMENT ON ME, ONLY TRIED ONCE BEFORE ON ANOTHER RAT LUNGWORM PATIENT.

WHERE THEY BASICALLY INFUSED ME WITH LIDOCAINE.

THE IDEA WAS TO TURN OFF MY NERVOUS SYSTEM.

AND GOOD LIKE, IF IT'S BROKEN, TURN IT OFF TURN IT BACK ONLINE.

DID THAT WITH MY NERVOUS SYSTEM.

IT WORKED.

COULD TALK INSTEAD OF SCREAMING IN PAIN FOR ONCE.

>>Yunji: BRING YOU THE UP PHOTOGRAPH.

EXPLAIN WHY YOU HAVING NERVE SYMPTOMS, PAIN.

TELL WASSON WE'RE SEEING RIGHT HERE.

>> ONE OF COOL THINGS ABOUTING SCIENTIST AND UNDERSTANDING VALUE OF RESEARCH WE DID RESEARCH ON ME.

I WANTED TO KNOW WHAT WAS WRONG.

DID A BIOPSY.

BECAUSE IT'S REALLY HARD TO CONFIRM THE TYPE OF DIAGNOSIS THAT I HAD.

NOT RAT LUNGWORM, WE COULD CONFIRM WITH MOLECULAR METHODS, SMALL FIBER, MALL FIBER NEUROPATHY WHICH I HAD.

IN THE TOP PICTURE, NORMAL PERSON.

WE HAVE THESE LARGE FIBER NERVES THEN SMALL FIBER NERVES.

SMALL FIBER NERVES BASICALLY CONTROL YOUR SENSE OF TOUCH AND TEMPERATURE AND PAIN AND ITCHINESS.

CONTROL AUTONOMIC FUNCTIONS.

UNCONSCIOUS, HEART RATE, BLOOD PRESSURE, PARASITOSIS OF YOUR INTESTINE AND TO BREATHE, GO TO THE BATHROOM.

ENDOCRINE SYSTEM.

BASICALLY WHEN THEY THINK HAPPENED, BECAUSE I WAS FEELING SO MUCH PAIN, THEY DID THESE LIKE LITERALLY SHOCKED ME.

THAT'S HOW YOU TEST IF YOU HAVE NERVE ISSUES.

LITERALLY SHOCK YOU.

AND THEY SAW THAT MY LARGE NERVES, I WAS RESPONDING NORMALLY.

THERE'S NO WAY TO KIND OF GET AT THE SMALL FIBER NEUROPATHY KIND OF DIAGNOSIS.

SMALL FIBER NEUROPATHY.

WHEN YOU'RE NOT THERE, YOU FEEL EVERYTHING AT ONCE.

LIKE YOU'RE UNDER THE CRUCIATUS CURSE.

IN THIS PHOTO SHOWS A PERSON WITH A NORMAL NERVE FIBER DENSITY.

YOU SEE ALL THE LITTLE SQUIGGLES.

ALL OF YOUR SMALL NERVE FIBERS.

AND THEN BOTTOM IS MINE.

YOU CAN SEE THERE'S NO LITTLE SQUIGGLES.

TREATMENT PROCESS, YOU TREAT WITH ALBENDAZOLE TO KILL THE PARASITE.

REST OF THE PROCESS IS REALLY PAIN MANAGEMENT.

THERE'S NO REALLY ANYTHING GROW YOUR NERVES.

THINK OF IT LIKE IT'S A FOREST FIRE.

WORMS THAT COME INTO YOUR BODY ARE LIKE A FIRE THAT IS RAGING THROUGH YOUR FOREST.

EVEN THOUGH YOU BRING IN THE FIRE DEPARTMENT, AND QUENCH THE FLAMES, THE DAMAGE IS STILL THERE.

IT'S STILL A CHARRED FOREST THAT NO LONGER FUNCTIONS LIKE A FOREST.

AND IT TAKES REALLY REALLY LONG TIME AND A LOT OF CARE IN ORDER TO REGROW THAT FOREST BACK TO WHERE IT SHOULD BE.

YOU CAN TOTALLY DO IT.

BUT IT'S CHALLENGING.

SO MANY OF US THAT WORK IN THESE TYPES OF CONSERVATION ROUTES KNOW THAT.

WHEN YOU BURN DOWN A FORCE, NATIVE FOREST, YOU DON'T NECESSARILY GET A NATIVE FOREST TO GROW ALL THE WAY BACK.

SO THIS IS KIND OF THE PROCESS THAT I'VE BEEN GOING THROUGH FOR THE PAST 30 MONTHS ON THIS JOURNEY.

IT'S A JOURNEY.

NERVES GROW REALLY SLOWLY.

ONE MILLIMETER A DAY.

>>Yunji: WOW.

JUST INCREDIBLE.

>> THANK YOU FOR SHARING THAT WITH US.

JOE, I WANT TO GET YOUR TAKE ON THIS.

HOW PREVALENT IS THIS?

HOW CONCERNED SHOULD WE BE?

WHAT DR. FRANK IS DESCRIBING SOUNDS TERRIBLE.

HOW MUCH OF THIS PARASITE IS IN OUR COMMUNITY AND WHAT ARE YOU SEEING IN TERMS OF TRACKING CASES?

>> DIFFICULT QUESTION.

NEED BETTER TESTING METHODS TO CATCH PEOPLE IN EMERGENCIES.

EARLY DAYS, WE LOOKED AT THE SPINAL FLUID TO SEE IF WE COULD SEE WORMS IN THE SPINAL FLUID.

CONFORMATORY TEST.

SPINAL FLUID ABSENCE OF THAT, PHYSICIANS CONTACT WITH SNAILS OR SLUGS, COULD MAKE A DIAGNOSIS RECENTLY PCR TEST.

THAT CAN AMPLIFY MATERIAL FROM THE WORM.

AND IT'S A GOOD TEST.

IT'S NOT PERFECT YET.

WE NEED BETTER SENSITIVITY.

I CAN TELL YOU OUT OF THE 36 SAMPLES THAT WE RECEIVED IN THE LAST FIVE YEARS, 7 YEARS, I GUESS, 90 WERE CONFIRMED.

AND THEY SEND IT TO US BECAUSE THEY HAVE A PROVISIONAL DIAGNOSIS.

THIS PERSON AFFILIATED.

SYMPTOMS THAT MAY BE RAT LUNGWORM DISEASE.

BUT THE TESTS DEPENDS ON CERTAIN LEVEL OF EOSINOPHILS IN THE SPINAL FLUID.

DOESN'T REFRESH THE THRESHOLD OF 10%, DON'T PICK IT UP IN THE TEST.

TESTING COMING ON.

STATE LAB, EVERYBODY WANTS THAT TEST THAT IS GOING TO DIAGNOSIS THIS EARLIER BECAUSE THE EARLIER, CAN TELL US THAT THE BETTER.

IN TERMS OF TREATMENT.

EITHER WITH ALBENDSOL OR PREDNISONE.

WHAT WE'RE LOOKING FOR.

TRY OUR BEST TO HELP THEM WITH DIAGNOSIS.

DO A LOT OF EPIDEMIOLOGY.

GO OUT TO THE CASES WITH VECTOR CONTROL.

LOOK WITH THE SLUG AND RAT BURDEN IS THERE, GIVE THEM INFORMATION HOW THEY CAN MAYBE CLEAN UP THINGS.

WORK WITH THE FARMERS AND STUFF.

IT'S THERE.

IT'S MORE PREVALENT IN THE WET SEASON.

WHY WE DON'T SEE SO MANY RIGHT NOW HARD QUESTION.

UNLESS IT'S JUST LOW BURDEN ON THE PEOPLE THAT HAVE BEEN EXPOSED.

ONE OR TWO WORMS HAVE A HEADACHE FOR A FEW DAYS VERSUS SOMETHING WE JUST HEARD ABOUT.

TRULY FRIGHTENING.

WITH LARGE GROUP OF WORMS.

>>Yunji: TALK ABOUT HOW THIS IS CONTRACTED.

IT SOUNDS LIKE EATING RAW PRODUCE PRIMARY MECHANISM.

CAN YOU TELL US A LITTLE BIT ABOUT THAT?

>> DIFFICULT ISSUE.

OBVIOUS METHOD THAT YOU EAT A SNAIL.

SLUG DELIBERATELY OR ACCIDENTALLY.

EATEN IT DELIBERATELY, KNOW ABOUT IT.

EATEN IT ACCIDENTALLY, WE MAY NOT EVEN KNOW ABOUT IT.

MAY JUST BE DEFAULT ASSUMPTION THAT YOU MUST HAVE DONE THAT IF THERE'S NO OTHER OBVIOUS METHOD THAT PATIENT CAN TELL YOU ABOUT OR WHATEVER.

>>Yunji: SNAILS ARE SMALL.

>> WELL, IT'S NOT ‑‑ PRETTY MUCH ALL THE SPECIES OF SNAILS THAT WE HAVE HERE, MOST OF THEM NONNATIVE INVASIVE SPECIES ONE HAS TO ASSUME CARRY RAT LUNGWORM DISEASE.

WE HAVE SCREENED A WHOLE BUNCH THEM, DIFFERENT SPECIES.

VARY ANY THE LEVEL INFECTION, EACH INDIVIDUAL SNAIL.

ALSO ACROSS SPECIES.

SO ONE THING THAT WE HAVE FOUND, IS THAT THE VERY SMALL SNAILS, PARTICULARLY OF THE SPECIES THAT ONLY EVER GET TO THE SORT OF BIG, AS OPPOSED TO THE GIANT AFRICAN SNAIL, CAN KIND OF BE THIS BIG, THEY CAN CARRY THE PARASITE.

OBVIOUSLY, YOU COULD MISS ONE OF THOSE IN A SALAD OR SANDWICH OR WHATEVER.

WOULDN'T KNOW THAT.

SO WE CAN'T SAY FOR SURE THAT EATING SOMETHING ON EAT AGGIE SNAIL THAT YOU GOT MIXED UP WITH YOUR LETTUCE IS THE PRODOMINANT WAY PEOPLE GET INFECTED HERE.

IT'S SORT OF DEFAULT ASSUMPTION IF THERE IS NO OTHER OBVIOUSLY OF GETTING MIGHT HAVE GOT INFECTED.

ONE THING WE OFTEN GET ASKED, PERHAPS SOMEONE IS GOING TO ASK THIS, MAYBE I'LL PREEMPT THEM, PEOPLE OFTEN ASK CAN YOU GET IT FROM THE SLIME THAT THE SNAILS LAY DOWN IN THE SLIME TRAILS ON THE LEAF OF LETTUCE FOR INSTANCE.

ANSWER TO THAT IS THAT IS NOT ENTIRELY CLEAR.

UP UNTIL RECENTLY, I MEAN, UP UNTIL ONGOING EXPERIMENTS IN MY LAB RIGHT NOW, SIX STUDIES OF RELEASE OF RAT LUNGWORM LARVAE IN SNAIL SLIME.

THESE HAVE BEEN DONE IN JAMAICA, IN MALAYSIA, COUPLE OF STUDIES HERE, ANOTHER STUDY IN NEW CALIDONIA.

AND THESE STUDIES, SOME OF THEM GO BACK IN THE 1960S.

COME UP DIFFERENT SPECIES OF SNAILS, SLUGS, AND DONE MOSTLY RATHER MINIMALISTIC EXPERIMENTS.

ONE OF THEM JUST WAS I HAVEN'T SEEN MANY WORMS COMING OUT OF SNAILS.

THAT WAS IT.

OTHERS WERE A BIT MORE RIGOROUS BUT NONE OF THEM SHOWED LARGE NUMBER OF WORMS BEING RELEASED IN THE SLIME.

MIDDLE OF AN EXPERIMENT RIGHT NOW.

I CAN'T REALLY TELL YOU ANSWER BECAUSE I DON'T KNOW THE DEFINITIVE ANSWER.

HAVEN'T DONE ALL THE ANALYSIS.

SOON, IN A COUPLE OF MONTHS, BE ABLE TO TELL YOU THE RESULTS OF THAT EXPERIMENT.

IN WHICH GRAD STUDENT RUN OVER 200 SLUGS WHAT WE CALL SEMISLUGS.

THING CAUSED PROBLEM.

SEEMS TO BE AT THE CENTER THE PROBLEM ON THE BIG ISLAND.

THIS ONE PARTICULAR SPECIES.

WHICH WE KNOW TO BE HEAVILY INFECTED.

SHE'S DONE EXPERIMENT WHERE SHE HAS LOOKED AT DIFFERENT LEVELS OF INFECTION IN THE SHRUGS.

TO SEE WHETHER THE MORE INFECTED YOU R THE MORE YOU RELEASE IF YOU RELEASE ANY AT ALL.

DIFFERENT LAYERS OF STRESS.

THAT WE SUBJECT THE SNAILS TO.

AND TO SEE WHETHER THAT ALSO CAUSE REALLY SMALL LARVAE.

HINTS OF BOTH OF THOSE THINGS ARE TRUE.

BUT NOT GOING TO STATE MY LIFE ON THIS.

HAVEN'T FULLY ANALYZED RESULTS.

HOPE TO GET IT PUBLISHED EARLY NEXT YEAR.

WE HAVE ANOTHER CHANCE.

WE'RE MORE ON THE BIG ISLAND.

HAVE A LOT OF CATCH.

SYSTEMS.

AND CATCHMENT SYSTEMS.

SNAILS AND SLUGS CLIMB UP SO IF THEY'RE NOT CLOSED, THEY GET INSIDE AN WE HAVE SOME EVIDENCE THAT SOME OF THE TRANSMISSION HAS BEEN THROUGH THESE CATCHMENT SYSTEMS.

OF COURSE, ALLUDED TO MAUI CASE SOME GONE FROM A BOWL OVERNIGHT.

SIX OR EIGHT CASES OF RAT LUNGWORM FROM THAT EVENT.

SO THEY CAN GET IN PLACES BESIDES VEGETABLES AND FRUITS.

CATCHMENT IS ANOTHER WAY, SO PEOPLE NEED TO BE CAREFUL IF THEY'RE GOING TO LIVE ON CATCHMENT SYSTEM.

FILTERING WATER, DOING WHAT THEY NEED TO DO.

>>Yunji: HOW TINY THESE WORMS ARE.

SEEMS HARD TO FILTER OUT.

>> FILTER SYSTEMS WILL DO IT.

UNFORTUNATELY, THE SMALLER THE PORE SIZE, MORE EXPENSIVE.

WORTH MONEY.

>> THAT'S GOING TO BE YOUR DRINKING WATER.

>>Yunji: TALK A LITTLE BIT ABOUT THE TREATMENT.

AND DIAGNOSIS.

SAYING THAT IT TOOK 17 DAYS TO FIGURE OUT WHAT WAS HAPPENING WITH HER BODY.

BECAUSE THE SYMPTOMS ARE SO DIVERSE.

TELL US A LITTLE BIT ABOUT WHAT ARE SORT OF MORE TYPICAL SYMPTOMS FOR THIS DISEASE AND HOW SOON IT CAN BE IDENTIFIED?

>> SYMPTOMS LATE TO INTENSITY OF INFECTION EXACTLY WHERE THE PARASITE IS CAUSING THE PROBLEM.

SO YOU GET THIS WHOLE RANGE OF SYMPTOMS.

AND IT MAKES IT VERY DIFFICULT FOR ANY SIGNIFICANCES OR ANY MEDICAL PROVIDER IF YOU LIKE, TO COME TO A RAPID DIAGNOSIS.

SYMPTOMS CAN BE JUST BIZARRE.

CONFUSING.

THEY DON'T REALLY MAKE SENSE.

THEY DON'T FIT WITH ANY OBVIOUS DISEASE IF YOU LIKE.

AND THEN IT'S VERY CHARACTERISTIC AT LEAST IN MY EXPERIENCE, PEOPLE DESCRIBE THESE SYMPTOMS IN A VERY FLUID THEATRICAL WAY.

BECAUSE OF WHAT THEY'RE EXPERIENCING.

IT'S VERY DRAMATIC.

BUT PEOPLE TALK ABOUT ELECTRIC SHOCKS AND I'VE NEVER HEARD OF MAGICAL POWERS BEFORE.

IT'S ALSO STUFF COMES OUT.

FOR BUSY CLINICIAN, THE TEMPTATION IS TO THINK THIS PERSON IS VERY ANXIOUS, OR THEY'RE IMAGINING ALL OF THESE THINGS GOING ON.

AND THEY GET DISMISSED AND YOU SEE THIS CHAIN OF EVENTS WHERE PEOPLE GO TO THEIR REGULAR PHYSICIAN, GO TO URGENT CARE, GO TO EMERGENCY ROOM, FRAGMENTED CARE.

NOBODY REALLY NAILS DOWN WHAT THE DIAGNOSIS IS.

SO 17 DAYS IS NOT UNUSUAL AT ALL.

IN FACT, I THINK YOU WERE VERY LUCKY, PHYSICIANS WHO WERE INVOLVED HAD A VERY HIGH LEVEL OF CONCERN ABOUT THIS DISEASE.

THEY WERE AWARE OF IT AND THEY MADE THE DIAGNOSIS EARLY.

UNFORTUNATELY, EVEN THAT CAN BE A BIT LATE.

17 DAYS.

SOME OF THE WORK THAT WE'VE DONOR LOOKED AT SUGGESTS THAT YOU REALLY NEED TO MAKE DIAGNOSIS AND START TREATMENT WITHIN 15 DAYS OF GETTING INFECTION.

THAT'S A VERY QUICK SORT OF PROCESS.

CAN TAKE WEEK OR TWO FOR SYMPTOMS TO ACTUALLY ARISE.

SO.

>>Yunji: THAT'S COUNTING AGAINST THE 15?

>> EXACTLY.

HOW CAN YOU POSSIBLY MAKE THAT DIAGNOSIS?

PEOPLE HAVE TO HAVE VERY HIGH LEVEL OF CONCERN ABOUT THIS DISEASE.

THE MOMENT THEY GET ENOUGH EVIDENCE, THIS IS WHAT IS GOING ON, THEY START TREATMENT.

WE THINK PEOPLE SHOULD START TREATMENT WITH STEROIDS, HIGH DOSE STEROIDS AND ANTI‑WORM MEDICINE.

ALBENDSOL.

SHOULD START TREATMENT BEFORE YOU'VE GOT ABSOLUTE CONFIRMATION OF THE DIAGNOSIS.

CLOCK IS RUNNING.

YOU CAN'T WAIT.

SEVERAL DAYS TO GET CONFIRMATION.

IF YOU LIKE IT.

SO YOU HAVE TO START TREATMENT VERY EARLY ON.

>>Yunji: BECAUSE IF YOU DON'T?

>> THAT'S WHEN PEOPLE GET INTO REALLY BIG TROUBLE.

THE WORMS,WHEN THEY GET INTO YOUR BODY, ARE TINY.

THEY'RE MICROSCOPIC.

>> YOU CAN'T SEE THEM.

BUT THEY GROW ONCE THEY GET INTO THE BRAIN, THEY GROW INTO QUITE LARGE WORMS THAT ARE CAUSING A LOT OF DAMAGE.

SO I DON'T THINK IT'S OVERSIMPLIFYING IT.

YOU JUST THINK KILL THEM WHILE THEY'RE TINY.

DON'T WAIT FOR THEM TO GROW BIG, LARGER WORMS.

WHEN THEY ACTUALLY DIE, THEY'RE GOING TO CAUSE A MAJOR INFLAMMATORY REACTION.

>>Yunji: WE'VE GOT QUITE A FEW VIEWER QUESTIONS.

DO YOU KNOW, DO YOU HAVE ANY IDEA WHERE YOU MAY HAVE CONTRACTED THIS?

>> IT'S A GREAT QUESTION.

AS SOMEBODY WHO STUDIES ROBES IN MUD, GROWING TASTING MUD, CHASING THE LEO, EDIBLE MUD OF KAWAINUI.

IRONIC, LEAST LIKELY PLACE WHERE I CONTRACTED THIS.

DURING COVID.

HADN'T BEEN IN THE FIELD A LONG TIME.

MY HUSBAND AND I MADE A VERY THOUGHTFULLY, WANTED TO SUPPORT OUR LOCAL COMMUNITY.

SO ALL OF OUR PRODUCE, ALL OF OUR PURCHASES, ARE FROM LOCAL FARMERS MARKETS FROM LOCAL FARMS, TO SUPPORT OUR FARMERS DURING THIS REALLY HARD TIME.

AND IT JUST LIKELY HAPPENED THAT A TINY SNAIL OR BIG CHUNK OF LAVA LOAD WAS IN A BITE THAT I CONSUMED.

AND YOU KNOW, IT HAS, THERE'S PTSD.

I DON'T EAT ANYTHING RAW NOW.

NOTHING, UNLESS IT HAS LIKE A SECURITY GUARD COAT LIKE A BANANA OR AN ORANGE.

BUT IT SADDENS ME WHEN THINGS LIKE THIS CREATE FEAR.

PEOPLE DON'T WANT TO SUPPORT OUR LOCAL FARMERS.

THAT IS WHAT I REALLY DON'T WANT TO HAPPEN BECAUSE IT'S NOT FARMERS' FAULT.

YOU KNOW, THERE ARE A LOT OF FARMERS ARE VERY PROACTIVE ABOUT THIS ISSUE.

AND THEY INSTITUTE VERY STRINGENT WASHING PRACTICES BEFORE THEY GO TO MARKET.

BUT ALSO, YOU KNOW, RECOGNIZING THAT THIS IS EVERYWHERE.

JUST BECAUSE THERE'S NOT A LOT OF PEOPLE THAT GET INFECTED, DOESN'T MEAN THERE'S NOT A LOT OF SNAILS AND SLUGS CARRYING THIS PARASITE IN OUR ENVIRONMENT.

SO AS WE THINK ABOUT DIVERSIFYING OUR AGRICULTURE, RIGHT?

LIKE TRADITIONALLY, WE HAD KALO, WALA, ULU, TARO, SWEET POTATO AND BREADFRUIT.

HAD TO BE COOKED FOR A LONG TIME.

TRADITIONAL FOODS YOU COOK FOR A REALLY LONG TIME.

START DIVERSIFYING GROWING KALE NEXT TO KALO THAT HAS HUGE AMOUNTS OF SEMI SLUGS GROWING WITHIN THE KALO, HA STRUCTURE, THAT WE DON'T EVEN SEE, BECAUSE WE END UP COOKING IT FOR 3 HOURS UNDER PRESSURE.

THINKING ABOUT THOSE LAYERS OF HOW DO WE ACTUALLY DIVERSIFY OUR AGRICULTURE HERE.

TO SUPPORT OUR PEOPLE.

AND OUR COMMUNITIES DURING TIMES OF PANDEMIC.

WITHOUT INTRODUCING THESE INTRODUCED PARASITES INTO OUR POPULATION.

>>Yunji: BRING YOU SOME OF THESE VIEWER QUESTIONS.

WHAT IS THE BEST ADVICE FOR HOME GARDNERS TO PREVENT GETTING RAT LUNGWORM?

FROM ERIC IN KAILUA.

AND LISA IN PAHOA.

DID REFERENCE THAT WE'RE SEEING A LOT OF THIS ON SOUTH SIDE OF THE BIG ISLAND.

IS THIS DISEASE HAWAIICENTRIC?

LISA LIVES IN PAHOA.

I'M ASSUMING WHY SHE'S ASKING THAT.

WHERE ARE WE PRIMARILY SEEING THIS AND ADVICE TO HOME GARDNERS AND PEOPLE WHO ARE GROWING THEIR OWN FOOD HOW TO KEEP THIS OUT OF THEIR YARD.

>> BIG ISLAND HAS MANY MORE CASES THAN ALL THE OTHER ISLANDS COMBINED.

VERY PREVALENT THERE.

INTERESTING SOME OF THE LOCAL FARMERS CAME OUT TO SOME OF THE MEET THAT'S WE HELD, WITH THE AG.

THEY WOULD RAISE THEIR GARDEN.

OR THEY WOULD PUT REALLY SHARP GRAVELLY ROCK AROUND THEIR GARDEN.

SNAILS DON'T LIKE TO GO ACROSS THAT TO GET INTO THEIR PLANTS.

ADVISE THEM, THEY HAD IDEA, IF THEY HAVE THIS PESTICIDE FREE GARDEN, THEY COULD REACH DOWN AND GRAB TASTY LETTUCE AND EAT IT RATE THERE ON THE SPOT.

NOT THINKING ABOUT WHAT ELSE MIGHT BE IN THERE.

SO GRAZING IS NOT A GOOD IDEA.

YOU CAN GROW IT.

BUT YOU HAVE TO DO THE SAME THING.

WASH WITH OUR LETTUCE.

VERY WELL.

UNDER GROUNDING WATER, THAT WORKS.

THINGS THEY CAN DO RAISE YOUR GARDEN.

A LOT OF FARMERS WENT TO HYDROPONIC.

SO IT'S RAISED ON PLATFORMS.

HAVE COPPER AROUND THE LEGS.

BECAUSE THEY DON'T REALLY LIKE TO CROSS COPPER.

TWO METAL STRIPS THAT IF THEY TOUCH THE OTHER STRIP, GET ELECTRIC SHOCK.

PACK DOWN.

AND GRAVEL.

DOING A LOT OF THINGS LIKE THAT TO PROTECT THEIR CROP.

BUT EVEN SO, WE GET IT.

NICE MAUI HYDROPONIC, WE WASH EVERY LEAF ANY WAY JUST BECAUSE.

>>Yunji: KIMO ON FACEBOOK SAYS WHERE WE CAN GET TERRIBLE ON THIS TERRIBLE DISEASE AND WHERE HAVE A GOOD SEGUE FOR YOU AND REST OF OUR AUDIENCE.

CONTINUE OUR CONVERSATION HERE IN THE STUDIO IN JUST A MOMENT, TAKE MORE OF YOUR QUESTIONS WANT TO TAKE A BRIEF MOMENT TO SHARE A PREVIEW OF THE SECOND PART OF OUR SPECIAL PRESENTATION TONIGHT ON RAT LUNGWORM DISEASE.

DOCUMENTARY ACCIDENTAL HOST, STORY OF RAT LUNGWORM DISEASE, WILL BE AIRING RIGHT AFTER OUR SHOW.

HERE'S A SNEAK PEEK.

¶¶ ¶¶ >> WHEN I GOT SICK WITH RAT LUNGWORM, I WAS IN KAPAA.

HAWAII, ON A SKATEBOARD EVERY DAY, AND THEN I STARTED GETTING SICK.

>> WHAT HAPPENED WAS INTRODUCTION OF SEMI SLUG.

>> SEEM TO BE HEAVILY INFECTED WITH WORMS.

>> HIGHER THAN SOME OF THE OTHER SPECIES.

>> LOOKS PRETTY SUSPICIOUS TO ME.

PEOPLE GETTING IT.

>> EVERYTHING GOES IN THE MOUTH.

PROBABLY BY EATING A SLUG, MIXED UP IN A SALAD.

>> PROBABLY WHEN THEY'RE INGESTED OR MICROSCOPIC.

YOU CAN'T SEE THEM.

>> INTERESTING BECAUSE PARASITE DOESN'T WANT TO BE IN US.

NOT GOING TO COMPLETE THE PARASITE'S LIFE CYCLE.

REALLY INFECTION OF RATS.

CONSEQUENCE OF A PARASITE, SNAIL AND SLUGS IN DIFFICULT DISEASE TO DIAGNOSE.

SENT ME HOME.

ALLOWED WORMS TO CONTINUE MIGRATING.

>> SUDDENLY, I WAS IN ACUTE PHASE OF THE ILLNESS.

MOVING THROUGHOUT MY BODY.

HEART, LUNGS.

THE FACT THAT PARASITES ARE ACTUALLY MIGRATING THROUGH YOUR BODY IS CREEPY.

>> THEY GET TO BRAIN AND SPINAL CORD.

THEY DEVELOP.

>> MENTALLY AND PHYSICALLY, DEVASTATING.

>> THEY HAD A CLUSTER OF CASES, SOME OF THEM SO SEVERE, THAT THEY NEEDED INTENSIVE MEDICAL SUPPORT.

>> ONLY THING THAT YOU CAN DO IS HEAD BACK AND FORTH AND OPEN EYES.

>> SEE SPINAL CORD HERE.

AND HERE.

SEE THESE TRACK OF THE WORM TRAVELING THROUGH THE BRAIN.

>> WORMS ARE IN STUFF.

>> I WENT INTO A COMA.

IN THE HOSPITAL FOR 4.5 MONTHS.

HAD TO RELEARN EVERYTHING.

>> A LOT OF PEOPLE THAT HAVE BEEN AFFECTED, CAN'T WORK.

FINANCIAL SITUATION IS RUINED.

>> AS ECOLOGY OF PLACES CHANGE, INTERACTIONS WITH DIFFERENT PEOPLES WORLD BECOMES A SMALLER PLACE.

>> >> PROBABLY EXPECT TO SEE SOME OF THESE INFECTIONS POPPING UP IN OTHER PLACES OF WORLD.

>> THESE PARASITES ARE NOT GOING AWAY.

>> THIS DISEASE IS EMERGING DISEASE.

IT'S SPREADING.

WE'RE JUST ONE STATION UNDERWAY.

SPREADS ACROSS THE WORLD.

>>Yunji: IT IS FANTASTIC FILM.

AIRING RIGHT AFTER THIS SHOW TONIGHT.

PLEASE DO STICK AROUND HERE ON PBS HAWAII.

BACK TO OUR GUESTS ON THE CONVERSATION.

REMINDER YOU'RE WELCOME TO SEND IN YOUR QUESTIONS AND I WANT TO POSE THIS ONE TO YOU.

WE HEARD YOUR VOICE THERE IN THE FILM.

ARE THERE ANIMALS BESIDE SLUGS AND SNAILS THAT CARRY THE PARASITE?

DO WE, WE KNOW IT'S PRIMARILY THERE, BUT ARE THERE OTHER HOSTS OF THIS PARASITE?

>> A LOT OF ANIMALS THAT CAN HARBOR THE PARASITE.

BEHAVE IN A DIFFERENT WAY.

THEY'RE NOT, ACCIDENTAL HOSTS IF YOU LIKE.

I THINK DOCTOR CAN ANSWER THIS QUESTION WITH MORE DETAILS ABOUT IT OTHER THINGS THAT ARE INVOLVED.

>> SURE.

SO DIFFERENT LIKE DOCTOR SAID, DIFFERENT KINDS OF HOSTS.

>> MENTIONED ACCIDENTAL HOST.

WE ARE ACCIDENTAL HOSTS.

PARASITE DEVELOPS BUT ONLY UP TO A POINT.

CANNOT COMPLETE LIFE CYCLE IN US.

THEY DIE IN OUR BRAINS.

BUT THEY HAVE DEVELOPED A LITTLE BIT.

OTHER ANIMALS AND MAMMALS, BIRDS THAT CAN ACT AS ACCIDENTAL HOSTS.

OTHER CATEGORY WE JUST PUBLISHED PAPER ABOUT RECENTLY IS CALLED PARATENIC HOST.

CARRIER HOSTS.

THESE HOSTS DO, GET INFECTIONS THE SAME WAY RATS DO, WE DO.

BY EATING SNAIL THAT HAS THIRD STAGE LARVAE IN IT, THOSE LARVAE CANNOT DEVELOP AT ALL.

STAY STUCK AT THE THIRD STAGE.

SIT THERE UNTIL THAT, WHAT WE CALL PARATENICIC HOST IS EATEN BY SAY A PERSON.

MOST BIZARRE COLLECTION OF DIFFERENT KINDS OF ANIMALS FROM HERE IN HAWAII, WE HAVE FROGS.

WE TALK ABOUT COQUI FOR INSTANCE CAN CARRY RAT LUNGWORM.

FLAT WORMS, WHICH ARE THE BLACK WORMY THING THAT THEY'RE ABOUT 3 INCHES LONG, SNAIL, VERY VORACIOUS SNAIL.

GREENHOUSE FROG, FROGMORE WIDESPREAD THAN THE COQUI.

ONE THAT GOES VERY QUIET SORT OF LIKE THIS.

(DEMONSTRATING} CANE TOAD.

CENTIPEDE.

HATE THE 6‑INCH LONG CENTIPEDES.

>> PETRIFIED OF THEM.

PEOPLE IN CHINA, WHERE IT WAS FIRST DISCOVERED, THESE CAN CARRY RAT LUNGWORM.

THEY EAT THEM RAW.

CAN YOU BELIEVE IT?

CONVINCED THEY MUST HAVE TO CUT THE HEADS OFF.

>>Yunji: I HOPE SO.

>> THEY EAT THEM RAW.

CENTIPEDES HAVE BEEN SHOWN TO CARRY RAT LUNGWORM DISEASE HERE.

SAME SPECIES OF CENTIPEDE.

OTHER ANIMALS ELSEWHERE, THAILAND FOR INSTANCE, AND THAILAND, INDIA, SRI LANKA, EAT MONITOR LIZARDS OR PARTS OF MONITOR LIZARDS, I'M NOT GOING TO TELL YOU WHICH PART.

ENHANCE THEIR VIRILITY.

RAT LUNGWORM, VIRILITY IS SERIOUSLY COMPROMISED.

SEE A VIDEO OF CHILDREN.

KIDS LOVE TO PLAY OUTSIDE.

I THINK A LOT OF PARENTS MIGHT BE WATCHING WOULD THINK CAN I LET MY KIDS RUN OUTSIDE BAREFOOT ON THE LAWN KNOWING THAT THERE IS OTHER ALL OF THESE HOSTS FOR THESE PARASITES ALL OVER THE PLACE?

WHAT IS YOUR THOUGHT ON THAT?

>> CHILDREN ARE A REAL CONCERN.

PEOPLE LIKE TO LET THEIR CHILDREN PLAY IN THE GARDEN.

AND AT THE END UP PLAYING WITH SHRUGS AND SNAILS.

HANDLING THEM.

PUTTING THEM IN THEIR MOUTH SOMETIMES.

THEY CAN GET INFECTED THAT WAY.

AND WHEN THEY DO GET INFECTED, TEND TO BE MORE SERIOUSLY ILL THAN AVERAGE ADULT IF YOU LIKE.

I THINK IT'S ALL DOWN TO JUST THE SIZE.

IF YOU'RE GETTING CERTAIN NUMBER OF WORMS, IF YOU'RE JUST A SMALL CHILD, SMALL BABY, YOU'RE GOING TO GET SICKER THAN A LARGE ADULT INGESTING THE SAME NUMBER OF WORMS.

SO IT'S A REAL CONCERN WITH SMALL CHILDREN.

IDEA OF SAYING, WELL, YOU CAN'T ALLOW YOUR CHILDREN TO GO OUTSIDE AND PLAY, IS KIND OF, NOT VERY REALISTIC.

THERE ARE CERTAIN NUMBER OF CASES ON FAIRLY REGULAR BASIS.

THERE IS A CHILD IN THE DOCUMENTARY THAT YOU CAN SEE HIM LATER ON, SHOWS VERY WELL WHAT HAPPENED, HEAR MOTHER TALKING ABOUT HOW TRAUMATIC THE WHOLE THING WAS.

SHE WAS WONDERFUL IN TERMS OF HELPING HER CHILD RECOVER.

LAST TIME I SAW THE CHILD, HE WAS STILL IN THE PROCESS OF RECOVERING.

>>Yunji: RECOVERY PROCESS SOUNDS INCREDIBLY LONG.

YOU SAID THAT YOU'RE 30 MONTHS OUT NOW AND STILL RECOVERING.

TELL US ABOUT WHERE YOU ARE NOW IN THAT PROCESS TO RECOVER?

YOU GET TO THE 17 DAYS.

YOU FIGURE OUT WHAT YOU HAVE.

AND THEN IT SOUNDS LIKE IT'S JUST THE BEGINNING.

>> YEAH.

I THINK ONE OF OF CHALLENGING THINGS OF THIS DISEASE IS BECAUSE IT'S HITTING YOUR NERVOUS SYSTEM.

THERE'S A CASCADING EFFECT OF ALL OF THESE OTHER THINGS HAPPENING.

BASICALLY, HAVE KNOCKED BODY OUT OF BALANCE.

COMPLETELY OUT OF WHACK.

AND SO EVERYBODY IS GOING TO RESPOND DIFFERENTLY.

BUT YOUR BODY IS OUT OF BALANCE.

SYSTEM TAKE A BIT TO GET REBOOTED OR RESTARTED OR MIGHT NOT GET RESTARTED.

I THINK THE PROCESS AND YOU'LL SEE IT IN THE DOCUMENTARY, AFTER THIS, YOU KNOW, A LOT OF US HAD A LOT OF ISSUES WITH WALKING, WITH TALKING, WITH READING.

I COULDN'T REMEMBER WORDS.

MY JOB IS BASED ON MY BRAIN.

A LOT OF TIME, I WAS REALLY SCARED THAT THAT WAS SOMETHING I WASN'T GOING TO HAVE AT THE END OF THIS.

A LOT OF TIMES, I COULDN'T READ.

I COULDN'T WALK.

IT WAS DURING TIME OF COVID.

AND SO IT WAS KIND OF DO I GO INTO A HOSPITAL FOR PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, GET EXPOSED TO POTENTIALLY GREATER RISKS COMING IN SO OFTEN, OR DO I QUARANTINE AT HOME AND DO ALL OF IT KIND OF ON MY OWN.

AND THAT'S WHAT I DID.

I READ FROM ELEMENTARY LEVEL BOOKS EVERY DAY.

I HAVE A PH.D. AND I HAD TO START WITH DR. SEUSS LEVEL BOOKS AND WORK MY WAY UP EVERY DAY.

PRACTICES MATH.

READ OUT LOUD TO PRACTICE TALKING.

I PRACTICED WALKING.

MY DOG WAS THE BIGGEST HELP.

WE WOULD LITERALLY JUST WALKING ACROSS THE ROAD AND BACK.

WAS A HUGE SUCCESS FOR THE DAY.

SITTING UP NIGHT BED, AND FUNCTIONING HEAVILY ON CONVERSATION WAS A HUGE WIN FOR THE DAY.

SO I KNOW IT'S BEEN 30 MONTHS AND I OFTEN GETS FRUSTRATING SOMETIMES YOU WERE BEFORE WAS RUNNING AROUND, FISH POND, CARRYING GIANT POHAKU, BUILDING KUAPA AND HIKING UP MOUNTAINS TO COLLECT SAMPLES AND THOSE ARE LAYERS THAT I HAVEN'T QUITE GOTTEN BACK TO YET.

JUST KIND OF ACKNOWLEDGING HOW FAR I'VE COME IN THE PROCESS.

REMEMBERING LIKE TWO YEARS AGO, IN THIS TIME TWO YEARS AGO, THERE IS NO WAY I COULD HAVE TALKED AT THIS RATE AND THIS LEVEL.

I WAS SLURRING MY WORDS.

I WAS SPEAKING REALLY SLOWLY.

AND SO, IT'S A LONG, LONG ROAD TO RECOVERY.

NERVES, RECOVER VERY SLOWLY.

AND WE JUST DON'T REALLY KNOW THAT MUCH ABOUT THE NERVOUS SYSTEM.

DOCTORS WERE 100% SURE I WAS GOING TO GET BACK TO 80% AND I HAVE.

I DON'T KNOW ABOUT THE NERVOUS SYSTEM, EVEN AT 85%, WHETHER THAT 85% NEEDS TO BE RECALIBRATED TO MY NEW 100%, OR I CAN KEEP PUSHING AND RECLAIM THAT LAST 15% TO GET TO 100, I HONESTLY DON'T KNOW.

YOU'LL SEE IN THE VIDEO TOO, LIKE HAVING A SUPPORT SYSTEM, HAVING FAMILY AND POSITIVE ATTITUDE, AND JUST KEEP PUSHING FORWARD.

THAT IS I FEEL LIKE THAT IS WHAT KEPT ME MOVING AND YOU SMILE AND YOU PUSH AND YOU BE BRAVE.

>>Yunji: WOW.

WE HAVE A LOT OF PREVENTION QUESTIONS.

I THINK THESE ARE GOOD FOR YOU.

THEY'RE ALL ABOUT PRODUCE.

NOT SURPRISED.

SHOULD WE BE CONCERNED WITH CONSUMING PRODUCE FROM THE MAINLAND?

SIMILARLY, SOMEONE IN HONOLULU SAYS I BUY LEAFY GREEN VEGETABLES FROM WHOLE FOODS.

ORIGINATE FROM THE MAINLAND.

WHAT IS THE RISK OF THESE VEGETABLES IMPORTED AND THEN LINDA IN PEARL CITY, WHAT IS THE BEST WAY TO WASH VEGETABLES TO GET RID OF THE LARVAE?

ANOTHER QUESTION HERE, TO RINSE LOCAL FARMER'S MARKET LETTUCE IN BLEACH WASH?

FREEZE VEGETABLES.

COOK HIGH HEAT?

LOTS OF QUESTIONS ABOUT PREVENTING.

>> WASHING CLEAN WATER.

DON'T NEED VINEGAR.

>> CAN I ADD TO THAT?

WE DID SOME EXPERIMENTS ON WASHING SLUGS OFF LETTUCE TESTED PLAIN TAP WATER.

AGAINST BLEACH, DILUTE WITH BLEACH.

VINEGAR, SALTWATER.

IDEA IS NOT SO MUCH TO KILL THE SLUGS IN THERE, BUT TO WASH THEM OFF SO YOU DON'T EAT THEM.

AND BASICALLY, IT'S JUST POWER OF THE RUNNING WATER THAT KNOCKS THEM OFF.

YOU'VE GOT TO ‑‑ DON'T JUST RINSE THEM GENTLY.

VIGOROUSLY IN FAST‑RUNNING TAP WATER.

>>Yunji: WHAT ABOUT QUESTIONS ABOUT THE MAINLAND?

VEGETABLES COMING FROM THE MAINLAND?

>> PARASITES SEEMS TO BE IN REGIONS LIKE HAWAII.

WARM CLIMATES.

DO A LITTLE BIT OF RESEARCH TO WHERE YOUR LETTUCE CAME FROM.

THERE'S MORE THAN JUST THIS PARASITE THAT MIGHT BE ON LETTUCE.

WE'VE HAD SALMONELLA OUTBREAKS FROM SPINACH AND LETTUCE.

ALWAYS A GOOD IDEA TO RINSE THOROUGHLY ALL OF YOUR VEGETABLES AND STUFF.

THIS WHOLE PREVENTION THING, PUT OUT THESE FIVE THINGS YOU CAN DO.

FIRST THING IS WASH, WASH ALL OF YOUR VEGETABLES AND FRUIT BEFORE YOU CONSUME THEM.

TAKE CARE OF SLUGS AROUND YOUR HOUSE.

TALK ABOUT BABYPROOFING YOUR HOUSE.

SMALL, HAVE A BIG YARD MAYBE WANT TO BABYPROOF YOUR BACKYARD.

BUY A PAIR OF TONGS.

SEE A SLUG, DON'T HANDLE THEM.

USE TONGS.

THROW THEM IN THE KILL JAR.

RATS, ELIMINATE THAT PROBLEM.

COOKING TAKES CARE OF PARASITES.

160 DEGREES FOR 30 SECONDS, BOILING WILL KILL THE PARASITE COVERING WATER SOURCES SO THE SHRUGS DON'T FALL IN AND DROWN AND FALL APART, ALL OF THE WORMS CAN SURVIVE FOR A TIME IN THAT BOTTOM.

SO IF YOU DON'T HAVE ADEQUATE FILTERS ON THERE, YOU CAN GET IT THIS WAY.

IT'S NOT JUST ONE THING.

THE FIRST THING OF COURSE, YOU WANT TO DO THAT.

LAST THING I'LL SAY, DON'T TAKE THE TIKTOK CHALLENGE.

SWALLOW THING ON THE BED.

HE GOT IT.

COUPLE OF GUYS THAT FOUND OUT ABOUT THE CENTIPEDE DURING A FOOTBALL GAME IN FRONT OF A HOUSE, JUMPED UP, CUT IT IN HALF, EACH ATE HALF.

BOTH GOT RAT LUNGWORM DISEASE.

COUPLE OUT IN THE RAIN, BORED RACING SNAILS.

LOSER HAD TO EAT THE SNAIL.

HE GOT RAT LUNGWORM DISEASE.

DON'T TAKE THE DARE NO MATTER WHAT.

ESPECIALLY SOBERING GIVEN THIS.

SAY THAT YOU THINK THAT YOU MAY HAVE CONTRACTED THIS.

HOW DO YOU TALK TO YOUR DOCTOR ABOUT THE KIND OF TESTING THAT YOU SHOULD GET?

NOW WE ARE SPREADING AWARENESS ABOUT THIS.

PEOPLE MIGHT SAY, I HAVE SYMPTOMS.

MEDICAL PROFESSIONALS KNOW ENOUGH ABOUT THIS, KNOW WHAT TO LOOK FOR AND TEST FOR IT.

>> GOOD QUESTION.

I THINK IN THIS DOCUMENTARY, SEE IT WAS MADE TO EDUCATE MEDICAL PERSONNEL BUT ALSO GENERAL PUBLIC.

BECAUSE IT'S REALLY IMPORTANT THAT PATIENTS HAVE A HIGH LEVEL OF SUSPICION THEY MIGHT HAVE THIS DISEASE.

GO TO THE PHYSICIAN OR THEIR MEDICAL PROVIDER EARLY AS POSSIBLE.

AND ACTUALLY, MENTION IT.

I THINK I MIGHT HAVE RAT LUNGWORM DISEASE.

AND IF THE MEDICAL PROVIDER IS NOT TOO WELL AWARE OF THE DISEASE, THEY CAN REFER TO SOME OF THE INFORMATION THAT IS AVAILABLE DEPARTMENT OF HEALTH WEBSITE.

WE PUBLISH GUIDELINES THAT WERE DESIGNED MAINLY FOR MEDICAL PERSONNEL, BUT VERY CLEARLY, IT OUTLINES HOW TO MAKE THE DIAGNOSIS AND IMPORTANCE OF STARTING TREATMENT AS EARLY AS POSSIBLE.

AND I THINK A LOT OF US ARE AVAILABLE TO PHYSICIANS, MEDICAL PROVIDERS, IF THEY HAVE QUESTIONS ABOUT DISEASE, THEY CAN CALL US.

CLOCK IS RUNNING.

AND YOU NEED TO MAKE THAT DIAGNOSIS.

AND START TREATMENT AS SOON AS POSSIBLE.

WE THINK EARLY DIAGNOSIS, EARLY TREATMENT, IS PROBABLY THE WAY TO PREVENT SEVERE CASES.

AND NOT EVERYBODY GETS BETTER.

IT CAN TAKE A VERY LONG TIME.

I THINK THOSE OF US WOULD WENT TO ATTEND THE SUPPORT GROUP MEETINGS, ON THE BIG ISLAND, COULD REALLY BE IMPACTED BY THE SEVERITY OF THE DISEASE.

IT'S A LIFE CHANGING EXPERIENCE FOR PEOPLE.

NOT ONLY FOR THE PATIENT, BUT FOR THE CAREGIVERS.

AND LOOK AT THIS, WE'VE GOT TO TRY TO PREVENT THIS.

DISEASE TENDS TO BE MORE SEVERE IN HAWAII.

WE HAVE TO DO SOMETHING DIFFERENTLY.

AND I BELIEVE THAT EARLY DIAGNOSIS AND EARLY TREATMENT MAY BE THE KEY TO PREVENTING SOME THESE LONGTERM PROBLEMS.

>>Yunji: WE ONLY HAVE A FEW MINUTES LEFT.

WHAT ARE YOUR THOUGHTS ABOUT WHERE THIS PROGRESSING?

STUDYING THIS FOR STOP TIME.

DO YOU THINK THIS IS SOMETHING THAT WE SHOULD ALL BE AWARE OF, ON THE WAY, OR IS THIS SOMETHING THAT WE HAVE A GOOD HANDLE ON?

>> I WOULD SAY THAT HERE IN HAWAII, WE, IT'S PRETTY MUCH EVERYWHERE IN HAWAII.

WE HAVE TO ASSUME THAT.

LOGICAL FUNCTION.

BASED ON OUR SCREENING OF SNAILS FROM ALL OVER THE PLACE.

SO PRETTY MUCH EVERYWHERE HERE.

WE KNOW THAT'S NOT GOING TO GET MORE, PROBABLY NOT GOING TO GET MORE WIDESPREAD TO DIFFERENT PLACES.

ELSEWHERE, HOWEVER, IT'S STILL SPREADING ALL OVER WORLD.

ON THE MAINLAND.

SOUTHEAST.

PRIMARILY FLORIDA.

HUMAN CASES RAT LUNGWORM DISEASE CONTRACTED IN THE MAINLAND, SOUTH EASTERN STATES.

IT'S RECENTLY BEEN FOUND IN ISLANDS IN THE MEDITERRANEAN.

SO IT'S CLOSE TO EUROPE.

IT'S NOT PRESENT IN EUROPE.

YET.

OTHER THAN THOSE ISLANDS.

BUT IT'S POTENTIALLY SPREADING.

WE DON'T KNOW ITS DISTRIBUTION IN AFRICA.

AND SO IT'S STILL SPREADING.

PEOPLE AROUND THE WORLD ARE STILL LEARNING ABOUT IT.

WE JUST PUBLISHED ANOTHER PAPER, BOTH AUTHORS ON IT.

IN WHICH WE DID A SIMILAR THINGER WHAT THE MOVIE DID.

TRYING TO EDUCATE MEDICAL COMMUNITY ABOUT NOT JUST UNITED STATES, AND HAWAII, BUT GLOBALLY.

ABOUT THE LIKELY SPREAD OF THIS PARASITE AND DISEASE THAT IT CAUSES.

IT'S BY NO MEANS EVERYWHERE WHERE IT'S GOING TO GO.

STILL EMERGEING AND EMERGING INFECTIOUS DISEASE.

>>Yunji: I WANT TO MAKE SURE WE GET TO YOU BEFORE WE RUN OUT OF TIME.

WHAT DO YOU WANT PEOPLE TO KNOW ABOUT WHAT THIS HAS BEEN LIKE AND WHAT WOULD YOU TELL FOCUS WATCHING TONIGHT.

>> >> YEAH.

IT'S A CHALLENGING JOURNEY.

I THINK ONE OF THE CHALLENGES A LOT OF PEOPLE DON'T KNOW WHAT RAT LUNGWORM IS.

EVEN MY GRANDMOTHER, TWO MONTHS LATER THOUGHT I WAS TOTALLY FINE AND CONFUSED WHY I COULDN'T ANSWER THE PHONE OR COMMUNICATE BACK WITH HER.

ONGOING.

I WOULD NEVER WANT ANYONE ELSE TO EXPERIENCE THESE THINGS.

SO PLEASE WASH YOUR LETTUCE.

DON'T EAT LETTUCE.

EAT KALO.

OR ULU.

THINGS THAT YOU HAVE TO COOK.

BUT I ALSO DON'T WANT PEOPLE TO BE AFRAID OF ENGAGING IN THEIR ENVIRONMENT AND THEIR ECOSYSTEMS.

USE INTRODUCED PATHOGENS HAVE A WAY OF BRINGING FEAR INTO OUR COMMUNITIES SO WE DISENGAGE FROM OUR PRACTICES.

AND THAT IS HEARTBREAKING ME.

EVEN SOMEBODY WHO EXPERIENCED IT, I WANT OUR, I WANT TO SUPPORT LOCAL FARMERS.

I WANT TO MAKE SURER WE HAVE THE CAPACITY TO HAVE OUR KIDS RUNNING AROUND EATING DIRT, GROWING THEIR MICROBIOMES SO THEY BUILD HEALTHY IMMUNE SYSTEMS.

AND SO I THINK WE JUST NEED TO MAKE KALA.

BE AWARE.

WE NEED TO WATCH AND WE NEED TO KNOW THAT THESE THINGS ARE IN OUR SYSTEMS SO THAT WE CAN BE PROACTIVE ABOUT THAT.

IF YOU'RE A FARMER, OR YOU'RE FOR A COMMUNITY, DO SNAIL AND SLUG SURVEY.

LOOK AT WHAT YOU HAVE IN YOUR ENVIRONMENT AND THINK IS IT A BEST IDEA TO GROW PRODUCE THAT PEOPLE WILL EAT RAW, OR HOW CAN WE ESTABLISH BETTER WASHING TECHNIQUES?

SO YEAH.

WASHING TECHNIQUES.

>>Yunji: THANK YOU FOR BEING WITH US HERE TONIGHT.

THANK OUR GUESTS.

ROB COWIE, VERNON ANSDELL… KIANA FRANK AND JOE ELM.

NEXT WEEK, INSIGHTS IS TAKING A BREAK FOR THANKSGIVING BUT WE'LL BE BACK ON DECEMBER 1 TO TALK ABOUT HOLIDAY SCAMS.

INSIGHTS PBS HAWAII.

ALOHA AND A HUI HOU