No symptoms- do I have to be treated?

Posted by reneeplus6 @reneeplus6, Feb 5, 2018

I'm headed for my third Bronch on Thursday to try and figure out what to do next. Let's see if I can make a long story short. I should mention I'm 53 and otherwise in very good health.
Twice I've gone in for Bronchoscopies (due to strange ongoing coughs) and discovered the H-flu bacteria. Cough goes away with the treatment for H-flu. The last bronch 18 months ago also revealed MAC. I took the 3 antibiotic cocktail for one year. We stopped at a year as it brought on a strong depression bordering on suicidal thoughts. However, now my follow up CT scans show increased opacifciation and larger nodules.
I continue to feel great- no cough, tiredness, minimal mucus (but I also have allergies), no fever. I'm trying to figure out what happens if we do nothing- the best answer I get from my pulmonologist is that, if it eventually has to be cut out, it will be a bigger problem. I also have an appt with infectious disease in a couple weeks to get their take on it.
My only treatment right now is my acupuncturist who's treated me for several years for over all health. I guess my question is- if I tested positive for MAC but have no symptoms, do I have to be treated with medication?

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@tdrell

@reneeplus6 .....everyone’s situation is so unique.....I am a firm believer and practice getting 2nd and 3 rd if necessary opinion when indicated.Mayos
In Minnesota and National Jewish in Denver are two of the specialists in NTM.
In my medical journey with a now 3 year old cough without weight loss or fevers but MAC from a bronchoscope 18 months ago.....here is where I am at
.....just returned from one year follow up at NJH in Denver....met again with pulmonologist and ID DR who saw me one year ago.
......in spite of single sputum cultures growing bizarre bacteria.....my lungs are not infected with them...they land in there due to my silent aspiration from my gastric reflux which is compounded by my obesity and other factors listed.
Last year’s laryngoscopy revealed I have Vocal Cord dysfunction which is exacerbated by my acute allergic rhinnorherea ( all that continuous mucus dripping onto Vocal Cords)
I am allergic to molds but local allergist did not want to desensitize me cause the cardiac beta blocker I take might not allow adrenaline to work if I have an anaphylactic reaction....pulmonologist said go ahead.I should also be rinsing my nose out with saline washes.

I had one session with Speech Pathologist to learn exercises for cough minimization.....will have repeat in future.

The sleep obstruction apnea which was found on the bronchoscopy and confirmed by a sleep study and is being treated with CPAP has a role in all of this.
Repeat from a year ago CAT scan shows no bronchietasis....nothing new except bronchial wall thickening which is caused by the stomach contents getting in the lungs.
I asked both doctors what do I tell the local ID doctor who is Itching to treat me with the big 3 antibiotics.
“Tell him that the standard of care is to grow the bacteria in 3 serial cultures with sufficient colonization.....and that the CAT scan show active infection”
None of which I have.
Again to repeat Reneeplus6....get other valid expert opinions....be sure all bases covered......best of luck. Tdrell

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I wish and hope I could/can at least say my CT was stable

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@tdrell

All....I asked the ID doctor at NJH Re Nitric Oxide therapy for NTM treatment when I saw her a week ago. She brushed it off saying.....no proof of effectiveness.
Another question I was supposed to ask had to do Re cleaning Acapella equipment.
Soak 4 pieces in soapy tap water then rinse with water boiled for ten minutes.
Tdrell

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So lets get the evidence then

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@reneeplus6 , Hello Renee. My dr at the Mayo Clinic does not believe in using the three drug cocktail unless the bacterial colony is extremely high and a person is very ill with symptoms. He has other ways of treating mac. What you have described, to me; sounds like you may have bronchiectasis. People who get infected with mac will commonly also have bronchiectasis. Are you familiar with this?

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@pfists

@reneeplus6
My personal take is the get an infectious disease opinion and maybe a third opinion at a Mayo or somewhere.
It's a bit concerning that the ct is worse but having no symptoms is very encouraging.
Also would wait to see if a couple of Mac tests in a row come back positive.
I was positive to mycobacteria abcessus for a year with no treatment and have turned negative the last year. My doctors chose a wait and see approach.
I'm sure others will chime in here.
Take care
Shari

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@reneeplus6 , my doctor at Mayo takes the wait and see approach too. He said that many times the mac goes away on it"s own. He likes to treat with antibiotics, but not the Big 3 cocktIl. He did not use the wait and see approach on me because when I first went to him I was actually infected with pseudomonas. That one doesn't require a lengthy treatment. It was gone in 30 days. Several years after my first visit with this doctor, I did test positive for mac. I was put on monthly antibiotics indefinately. Still, not the Big 3, just one antibiotic for 10 days a month. I have been on this regimen for two years. So gar, it has been working for me. I never cough and seem normal with the exception of shortness of breath and low energy. I fefinitely jave a better quality of life now since attending the Mayo Clinic. I hope that you can find some peace with this disease. Hugs, Terri

REPLY
@tdrell

@reneeplus6 .....everyone’s situation is so unique.....I am a firm believer and practice getting 2nd and 3 rd if necessary opinion when indicated.Mayos
In Minnesota and National Jewish in Denver are two of the specialists in NTM.
In my medical journey with a now 3 year old cough without weight loss or fevers but MAC from a bronchoscope 18 months ago.....here is where I am at
.....just returned from one year follow up at NJH in Denver....met again with pulmonologist and ID DR who saw me one year ago.
......in spite of single sputum cultures growing bizarre bacteria.....my lungs are not infected with them...they land in there due to my silent aspiration from my gastric reflux which is compounded by my obesity and other factors listed.
Last year’s laryngoscopy revealed I have Vocal Cord dysfunction which is exacerbated by my acute allergic rhinnorherea ( all that continuous mucus dripping onto Vocal Cords)
I am allergic to molds but local allergist did not want to desensitize me cause the cardiac beta blocker I take might not allow adrenaline to work if I have an anaphylactic reaction....pulmonologist said go ahead.I should also be rinsing my nose out with saline washes.

I had one session with Speech Pathologist to learn exercises for cough minimization.....will have repeat in future.

The sleep obstruction apnea which was found on the bronchoscopy and confirmed by a sleep study and is being treated with CPAP has a role in all of this.
Repeat from a year ago CAT scan shows no bronchietasis....nothing new except bronchial wall thickening which is caused by the stomach contents getting in the lungs.
I asked both doctors what do I tell the local ID doctor who is Itching to treat me with the big 3 antibiotics.
“Tell him that the standard of care is to grow the bacteria in 3 serial cultures with sufficient colonization.....and that the CAT scan show active infection”
None of which I have.
Again to repeat Reneeplus6....get other valid expert opinions....be sure all bases covered......best of luck. Tdrell

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@tdrell, Hi Terri. That was excellent advice for Renee. As for you, have you ever been put on the medivation 'Singulair' for the rhinitis? I was put on it many years ago and it made a world of difference for me. I still take it

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@tdrell

All....I asked the ID doctor at NJH Re Nitric Oxide therapy for NTM treatment when I saw her a week ago. She brushed it off saying.....no proof of effectiveness.
Another question I was supposed to ask had to do Re cleaning Acapella equipment.
Soak 4 pieces in soapy tap water then rinse with water boiled for ten minutes.
Tdrell

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@tdrell, interesting about the nitrous oxide statement. I was curious a while back myself, so I looked it up on the NIH website. It stated there that it does work to kill off mac; but that it wasn't cost effective in the delivery , and that they are still working on that.

REPLY
@tdrell

All....I asked the ID doctor at NJH Re Nitric Oxide therapy for NTM treatment when I saw her a week ago. She brushed it off saying.....no proof of effectiveness.
Another question I was supposed to ask had to do Re cleaning Acapella equipment.
Soak 4 pieces in soapy tap water then rinse with water boiled for ten minutes.
Tdrell

Jump to this post

All.....that was the Aerobika....not Acapella.....
Also....here is a saga full of irony....so I had annual appts at NJH in Denver on Monday January 29, 2018. After review of CAT scan done there in November,and cultures grown there and in Wisconsin, and Pulmonary Function tests from that day, I was told lung function was stable from a year before....that GErD/aspiration of bizarre organisms into my lungs from stomach was my issue not infection....compounded by Vocal Cord Dysfunction....allergic rhinitis...obstructive sleep apnea...and obesity.
That was Monday, on Tuesday a productive cough started,....continued during my hour appt with Speech Pathologist Wednesday. For first time in my 73 years I had no appetite and went to sleep at 7pm and awoke exhausted at 10am.Somehow able to drop off rented car at Denver airport,shlep all my bags ( medical notes, medications,CPAP etc) to gate thanks to wheel chair assistance. Hacked the entire 2 hours of flight....wheel chair from gate ....hubby got bag....into car, called friend ...retired infection control nurse to confirm what I suspected I needed to do.....and did it. Went to Urgent Care 3 minutes from house....my regular Dr on duty......did nose swab....that came back with Influenza A.....put on steroids, Tamiflu and antibiotics since I had a purulent ear infection....so for 10 days, I have been vegging here at home recovering from my annual visit to respiratory hospital...and yes,,,,I did have the high dose flu vaccine in Sept.
I suspect I caught the grunge on plane going to Denver.....a woman sitting a few rows ahead and kitty corner coughed the whole 2 hours. Sadly everyone on the return flight had my germs spewed out on them. I now have learned to use the masks I had in my purse.take care all...tdrell

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@tdrell

All....I asked the ID doctor at NJH Re Nitric Oxide therapy for NTM treatment when I saw her a week ago. She brushed it off saying.....no proof of effectiveness.
Another question I was supposed to ask had to do Re cleaning Acapella equipment.
Soak 4 pieces in soapy tap water then rinse with water boiled for ten minutes.
Tdrell

Jump to this post

Is it cost effective for us to keep having repeat CT scan, lab work, long-term repeat visits to the Pulmonologist, Infectious Disease MD?We should see how the people use if for Pulmonary Hypertension.

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Can you summarized the recommendations other than the 3 antibiotics

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