NTM and Hawaii

Thank you for this information. It is difficult to make the hard decisions to forgo something you know you would enjoy. Having the knowledge that research would support that hard decision makes it a little easier.

I picked up my NTM, both Avium and Abcessus on the big island having lived there for 10 years. The Mykobacteria readily attach to the soil types there and enviro transpiration is heavy there so I felt the steam rising off the landscape from the heat and humidity was a risk factor. It will take me some deep soul searching before I go back and I miss it every day

Thank you so much for sharing your experience with us.
Ling

I knew soil type was a big factor - we have concentrations of peat nearby, but fortunately no open bogs - sadly I can no longer hike the nature preserves here that have open bogs, nor do I use it in my gardens and pots. But I never thought about the effect of the humidity putting the NTM directly into the air! Maybe that explains some of the geographic differences in infection.

We learn so much here from each other.
Sue

Sue, I hear the term Envirotranspiration in some of the research but my description is my own intuition kicking in, not necessarily that of the scientists. Now that I’m in the PNW, I think peat bogs are a factor as well. I try to keep my activities on salt water, and really enjoy romping around Puget Sound. Where are your peat bogs (where do you live) ?

If you think of air as a solution, it's dilute with mostly nitrogen, oxygen and small amount of carbon dioxide. Enter NTM type bacteria, from warm/hot shower via a home water heater. The experts say to dilute the bathroom air by opening a window, door, running an exhaust fan, reducing temp of water etc to decrease exposure to possible NTM. In other words, the air "solution" becomes more dilute. So, isn't that the same for the outdoors, one big dilute solution? (Assuming one doesn't stand over the steam coming off the landscape, breathe in over a bag of potting soil or dig in the bog etc?

The bogs are scattered throughout Minnesota. Some (covered by development) as near as a mile. As a teen, I used to tear through the never frozen bogs about 10 miles from here, but they are either developed or covered by sod farms now. We have a path of regional nature centers that follow the bogs north from the Twin Cities to nearly the Boundary waters, and I have always loved the diversity of plants and bugs there. Thank goodness for blogs, newsletters and web sites - I can peek at them remotely now.
Sue

You said, "In other words, the air "solution" becomes more dilute. So, isn't that the same for the outdoors, one big dilute solution?"

Yes, to an extent that is true. Exposure to infectious elements is a combination of time and concentration. So my conjecture is that an occasional "walk in the woods" with relatively high exposure probably isn't very high risk, but living on the edge of the rain forest, with constant exposure over time would be more risky as one inhaled small doses over a long period.

The same with exposure to peat. If I was a "patio gardener" who potted up a few plants to
enjoy every summer, and there was some peat in the soil mix - low risk. But I am a "dirty rat" - playing in numerous pots, plots and beds every day, sometimes for hours. So if I dumped peat in with my soil mix, I would be highly exposed. I do wear a mask or stay away when the beds are being greatly disturbed by digging & dumping, but all my joy would evaporate in an instant if I had to be N-95 masked all day in the heat!

So we each need to figure this out for ourselves - what risk level am I comfortable with? I am kind of middle-of-the-road.
I don't have NTM in my home water, so no boiling, short showers, etc - low risk
I don't worry about water or ice when I'm out, I shower in hotels - I consider both low-risk because of short, infrequent exposure.
I do keep my nebbing and airway clearance super clean - that air is being inhaled deeply into my lungs daily - high risk.
And, with compromised lungs, I am not only concerned about NTM, but pseudomonas, influenza, RSV and pneumonia - so I mask in airplanes & close indoor crowds and get vaccinated - high risk.

What does anyone else do to stay safe? What risks do you accept to live a life you are happy in?
Sue

I live in HI and am aware of Hondas study of bacteria in the water and soil. But you can still enjoy the islands. I am careful to mask when I work outdoors and with the soil and dust off and wash the cloths that I wear. I get hot water when going to a restaurant or bottled water and I clean my shower heads with antibacterial sprays. I think that shower heads and bacteria is everywhere besides HI. Just think that now we find that plastic invisible particles is everywhere. Hawaii is a wonderful mild climate with an ocean that filters clean air and generally we dont have the heatwaves large parts of the country is going through. I like what Sue often emphasizes that we should be reasonable as we live. I have had Bronchiectasis/MAC beginning three years now and so far all I do is to nebulize with 7% saline and .5% budesonide. Walk every other day or go to the gym and do yoga with inversions to get rid of mucus. I am 79 and so far I been managing.
Hal

Hi Hal,
I appreciate your posting. It makes me happy just reading it. The simple living style of the island alway appeals to me. I love being there, being there makes my heart sing. We spent some time on the island every year for many years, but last year I cancelled our trips after just being diagnosed with bronchiectasis and reading all these research papers. It seems so many odds work against me. On top of the risks for other people, I am Asian and thin, but not very thin though. So far bronchiectasis has not prevented me from doing the things I love, travel, hiking, seeing movies, going to concerts and dining out. I would be very sad to give up Hawaii. I do believe that the unique climate and unique soil composition made Hawaii a hot spot for NTM. But I don't know if we take the measures we take in the mainland, will that be enough? Your experience might give some proof. Since your diagnosis of MAC and bronchiectasis, have you noticed whether your conditions progressed? Have exams indicated any progression?
Anyway, many thanks again for sharing your life experience in Hawaii.
Take care!
Ling