NTM/MAC/MAI: We must advocate for ourselves

Posted by boomerexpert @boomerexpert, Aug 16, 2016

Throughout the US & its territories, a total of 8580 people are infected with Zika, a virus that is easily prevented and does not harm adults - it can cause birth defects in unborn children of infected people, but that can be prevented. The US is spending hundreds of millions of dollars to search for a vaccine.

In contrast, 1 of every 100,000 people (not including people with HIV) in the US are diagnosed with some form of NTM, most prevalent is MAC/MAI, and that figure is increasing. Under "NTM Facts, A Growing Problem" (https://www.ntmfacts.com/prevalence), here's a few alarming statistics:
"Currently, there are an estimated 86,000 cases of NTM lung infections in the US, and that number continues to grow more than 8% in prevalence every year. (with no requirement to report NTM infections as there is for TB, most researchers believe the number is far higher).
With the rise of NTM infections, data has shown that NTM is now more prevalent than TB in the US...it has been found that incidences of NTM are increasing while TB is decreasing around the US. ...The rates of NTM infection are increasing in patients aged 65 and over, a population
that is expected to double by the year 2030."

The infection went from one considered as opportunistic (effects mostly those who are very compromised, like the HIV infected) to one that has now invaded the general population.

Yet, by all research and medical standards, treatment with first 2, and now 3 (and in some cases 4) extremely powerful antibiotics is grueling (side-effects similar to those experienced with chemotherapy) thus difficult (for some impossible) to sustain as it must be taken 3X/day for at least 1 year, thus its effectiveness as a cure in many patients is spotty; for an increasing number it can only manage the infection, causing them to be on strong antibiotics for the rest of their lives.

In essence, the bug has become more prevalent (and perhaps stronger), and the medical community's response has been minimal research to ID current antibiotics that may work better than others, then increase the number used to treat it rather than find more appropriate treatments designed to kill this particular bacteria. Exacerbating the problem is the medical conundrum that taking these medications orally has a reduced impact on this infection deep in the lungs. Most researchers agree that the best solution is something that can be introduced directly to the lung via aerosol or inhalant.

Over the past 18 years, no significant research beyond that mentioned above has been conducted to find a more effective cure. The only clinical trial conducted over the past 5 years for an inhaled treatment, Amikacin, is generally being tested on those who have already failed traditional treatments, thus not supplanting them.

I believe that patients who endure the impact of this medical vacuum must push for more research, and better treatments, not just more clinically effective, but with far less side-effects. We can start by contacting top research facilities for this condition (U TX, National Jewish, Mayo Clinic, and the NIH, FDA) asking for more research. We can also talk with our physicians about better treatments, asking them to push for more research. Finally, we can continue to search for, and share, information on clinical trials for new NTM treatments, and our ideas for treatments that could work.

If these facilities continue to hear from a great number of people suffering from this insidious infection, it may have the "squeaky wheel" effect. Most assuredly if we remain silent, willing to trudge along with the existing treatments without asking for something better, we are likely to get nothing better.

I believe patients themselves can have a great impact on improving research. But...only if they hear from us.

Thoughts? Ideas?

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

@tdrell

@unicorn and @boomerexpert.....well no doubt The website bronchiectasis will report on the ATSociety results after May....
Is one client with cystic fibrosis AND NTM abscesses enough to draw conclusions on? Tdrell

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Do you have a contact number

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@katemn

@mac47 and @windwalker, Terri, I had just a few minutes so went back on my File Cabinet and found the below .. hope it helps! Hugs! Katherine

I personally have chosen to install the 0.2 micron filters shower heads .. they are costly and must be changed frequently so it is on a shower that only I use. I posted on the Forum how to purchase them if anyone is interested. They are the expensive "0.2 micron filters shower heads" for my shower that I have to replace monthly .. the name of the product is: Kleenpak™ Disposable Shower Head Filter.

BUT see the below:

1. You CANNOT prevent MAC/MAI .. the best thing written I've seen I put in my File Cabinet:

I LOVED THIS NOTE OF SANITY FROM MEMBER @maryjo2sell .. Mary Jo Just to join the discussion I think sometimes we can get carried away with prevention and protection from mycobacterium. We can filter our water pipes at home, then go to a restaurant and drink their water and use their ice cubes. We take a walk and pass water vapor from an air conditioner or a beautiful, decorative fountain. We work in our yard and get bacteria from the soil. There is no bubble. We should be cautious, but I don't think any of us truly know how we got our NTM. (non-tuberculosis mycobacterium). I got mine (Kansasii) years ago and was asked did I go to a foreign country. No-and I still have no idea how I got it while my husband and kids did not. I keep my faucets cleaned out and my shower heads, but I just went to a hotel when I went to Mayo. I doubt they cleaned their shower heads! So some prevention is good, but we have to live. (p.s. After I read Mary Jo's note I thought about I had just been to a movie the night before .. had a soda out of THEIR faucet with IT'S biofilm and had ice cubes from THEIR machine .. had not even thought about it! Plus had dinner at a restaurant before that .. just think about that .. heavens protect us!! Mary Jo is SO correct in bringing sanity to our conversation!)
PLUS from Dr Aksamit Mayo Clinic:

FILTERATION OF HOME WATER SYSTEMS Hello Katherine, Again, apologize for the delayed response. Let me share with you information received from a colleague, Dr. Joseph Falkinham from Virginia Tech University. He is one of the leading experts in the country and world, studying these very issues for many years. I might add that there is no definitive data as to whether any of these home water modifications of exposure will impact the clinical course of pulmonary NTM patients, and if so to what extent. Likewise, it is equally unclear as to what impact these modifications would have on minimizing risk of development of pulmonary NTM disease if changes are made prior to development of disease. Please let me know if additional information is needed or if I can clarify further.
Regards,
Dr. A
(from Dr. Falkinham)

(1) Even with installation of a 0.2 micron meter pore size filter, the house will always have NTM as they are in the pipe biofilms. They grow in the biofilm on nutrients in the filtered water and inoculate the water.
(2) As an alternative, I suggest filters on just those water sources where aerosols can be generated; namely a shower and a water tap in the bathroom...maybe even in the kitchen. Those places should only be used by the NTM patient, not everyone, as the filters are expensive and need regular replacement.
(3) The 0.2 micron filters clog, so it is important to pre-filter the water (1-5 micrometer filters). The larger pore filters are less expensive than the expensive 0.2 micro meter pore size filters.
Content above is information provided by Aksamit, Timothy R., M.D. on 03-Feb-2017 14:09
@pamelasc1, Pamela I think you hit the nail on the head. You would have to CONSTANTLY have the water tested for mycobacterium because as Dr. Aksamit said .. my kitchen special filtration system ONLY has 0.2 micron filtered water going through it .. but he said the faucet itself would STILL retain SOME moisture after use/shut off .. developing in biofilm in the faucet .. developing in mycobacterium!!

From one of our members: I got ONE of my mycobacterium (Kansasii) years ago and was asked did I go to a foreign country. No-and I still have no idea how I got it while my husband and kids did not. I keep my faucets cleaned out and my shower heads, but I just went to a hotel when I went to Mayo. I doubt they cleaned their shower heads! So some prevention is good, but we have to live.
p.s. After I read Mary Jo's note I thought about I had just been to a movie the night before .. had a soda out of THEIR faucet with IT'S biofilm and had ice cubes from THEIR machine .. had not even thought about it! Plus had dinner at a restaurant before that .. just think about that .. heavens protect us!! Mary Jo is SO correct in bringing sanity to our conversation!

NOTE: I saw Dr. Dulohery today .. good appt. As I have the energy I will say more .. BUT good info. She said to watch http://conference.thoracic.org/ for good information on new research on drugs being tried out for our diseases. Let's check it out and share anything we can find out! She is going to be attending .. hope she brings back good information for all the Mayo Team!Hugs! Katherine

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Hi Katherine. I live in an apt with two bathrooms and I have been only used one shower. I am thinking of using the unused shower, but I am scared of MAC and legionnaires and other bugs, which may be present. Aside from wearing an N95 mask, removing the showerhead and turning on the exhaust fan, how else can I protect myself? The filters that you use, what are they called and where did you buy them?
Thanks.
J

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@turnbacktheclock

Hi Katherine. I live in an apt with two bathrooms and I have been only used one shower. I am thinking of using the unused shower, but I am scared of MAC and legionnaires and other bugs, which may be present. Aside from wearing an N95 mask, removing the showerhead and turning on the exhaust fan, how else can I protect myself? The filters that you use, what are they called and where did you buy them?
Thanks.
J

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Good morning J, I am not Kate - she is no longer on Mayo Connect, but let me try to answer your questions...

First, I can see that you are fairly new to the group, and that perhaps you watched the NTM videos from MUSC, it that correct?

We each go through a period, early in our MAC journey, when we think we must do every single thing suggested to avoid the germs, and it feels overwhelming! Eventually we settle into a routine that works for us and allows us to continue to live our lives.

Here is a recent discussion where you might get some answers to your questions:
https://connect.mayoclinic.org/discussion/remodeling-and-shower-heads/
To chat with others who are concerned with water safety, you can read here:
https://connect.mayoclinic.org/discussion/have-you-had-your-water-tested/
One more tip to get replies - look at the date a post was made, the respond to a recent one using the "REPLY" button.
I hope this helps get the information you are looking for.
Sue

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@sueinmn

Good morning J, I am not Kate - she is no longer on Mayo Connect, but let me try to answer your questions...

First, I can see that you are fairly new to the group, and that perhaps you watched the NTM videos from MUSC, it that correct?

We each go through a period, early in our MAC journey, when we think we must do every single thing suggested to avoid the germs, and it feels overwhelming! Eventually we settle into a routine that works for us and allows us to continue to live our lives.

Here is a recent discussion where you might get some answers to your questions:
https://connect.mayoclinic.org/discussion/remodeling-and-shower-heads/
To chat with others who are concerned with water safety, you can read here:
https://connect.mayoclinic.org/discussion/have-you-had-your-water-tested/
One more tip to get replies - look at the date a post was made, the respond to a recent one using the "REPLY" button.
I hope this helps get the information you are looking for.
Sue

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Thank you, Sue.
Yes I am recently diagnosed with BE. I am scared, no, I’m petrified, of getting the germs. This support group has been a godsend.
J

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@turnbacktheclock

Thank you, Sue.
Yes I am recently diagnosed with BE. I am scared, no, I’m petrified, of getting the germs. This support group has been a godsend.
J

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Deep breath! I was terrified too when I was diagnosed over 4 years ago, after 2 years of not knowing and being constantly very sick - I had MAC & Pseudomonas as well as Bronchiectasis and went through antibiotic therapy. I stopped them after 18 months even though my sputum culture still said I had MAC, and switched to rigorous airway clearance and a healthy lifestyle. I am still doing fine, almost 3 years later.

My ID doc gave me the best advice ever "Bronchiectasis is a condition you learn to live with. Germs are everywhere; the only way to avoid them it to live in a bubble - and that's not really living. Take prudent precautions and get on with living your best life."

The most important thing I do to stay healthy is airway clearance. It keeps mucus from settling into my lungs and creating a warm, moist environment for germs to grow.

Have you been advised to do airway clearance? If you are not infected now, it is probably the most important step you can take.
Sue

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