Reducing Exposure to Nontuberculous Mycobacteria (NTM)

Posted by Armando @bolso1, Sep 16, 2021

Please see the attached document prepared by Dr. Joseph O. Falkinham, III, a world authority on the management of NTM dispersion.

Shared files

Reducing Exposure to Nontuberculous Mycobacteria (Reducing-Exposure-to-Nontuberculous-Mycobacteria.pdf)

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

@sueinmn

I agree that most distilled water I probably low risk, if bottled under sterile conditions. I use .2 micron filtered water because a filter that fine traps any mycobacteria.

I personally think there is a difference between steam from boiling water, which is highly unlikely to be contaminated, and "steam" from a shower, which is droplets water that is not hot enough to kill NTM. But I don't have any science to prove it.

I just think we get "way in the weeds" sometimes trying to avoid EVERY exposure. I try to concentrate on reducing big risks (eg indoor pools and hot tubs) and ignoring the small ones (getting my hair washed at the salon or opening the dishwasher that has run at 180⁰ for an hour.) I have been MAC free for 5 years and counting after almost 2 years of antibiotics.

Everyone is different and I respect that. My risk tolerance is probably higher than average in this group.

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Sue regarding your water filter. I think once you posted you have well water source. So what is and where is the 0.2 filter you use. I researched all water filters, reverse osmosis etc and I am so confused what to use so I still boil water, have the water heater set to 140 degrees and hope it’s enough for everyday kitchen use. Thank you

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@lilianna

Sue regarding your water filter. I think once you posted you have well water source. So what is and where is the 0.2 filter you use. I researched all water filters, reverse osmosis etc and I am so confused what to use so I still boil water, have the water heater set to 140 degrees and hope it’s enough for everyday kitchen use. Thank you

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My filter is in my kitchen water feed. It is a dual filter - first it goes through .9 micron, then through .2 micron. Sorry I cannot give a brand name - my husband is totally in charge of it. We have city water from a deep well in one location, my second has just changed to the same. Both kitchens have the same filter, plus the water heater at 135F or a bit higher in each. We do not drink or cook with water from the other taps in our house. I use the filtered water to make ice.

So far (over 6 years) this has been safe for me.

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@sueinmn

My filter is in my kitchen water feed. It is a dual filter - first it goes through .9 micron, then through .2 micron. Sorry I cannot give a brand name - my husband is totally in charge of it. We have city water from a deep well in one location, my second has just changed to the same. Both kitchens have the same filter, plus the water heater at 135F or a bit higher in each. We do not drink or cook with water from the other taps in our house. I use the filtered water to make ice.

So far (over 6 years) this has been safe for me.

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Thank you

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@lilianna

Sue regarding your water filter. I think once you posted you have well water source. So what is and where is the 0.2 filter you use. I researched all water filters, reverse osmosis etc and I am so confused what to use so I still boil water, have the water heater set to 140 degrees and hope it’s enough for everyday kitchen use. Thank you

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Lifestraw water pitcher filters to .2 microns. It's great!

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@sueinmn

I realize that both MAC and bronchiectasis seem daunting at first. With all cautions about mycobacteria being everywhere, and the meds being difficult, etc, I was frightened at first.

Then I began reading everything I could find about it, and it seemed like it was even worse...and somehow I found Mayo Connect and began reading posts by people who had lived with both for many years.

As I continued learning, I formed a philosophy that guides me. I am determined to live my best life, as fully as possible, in spite of having Bronchiectasis and having had severe MAC and Pseudomonas. I refuse to allow it to make me paranoid, or turn me into a recluse. (All those pandemic months further reinforce that decision.)

With that as my goal, here are the changes I have made:
Airway clearance with 7% saline nebs and add asthma meds as needed.
Wear an N95 mask and gloves when handling soil and mulch, and shower immediately after.
Don't garden in my Texas yard, where I probably got MAC. Stay inside, wear a mask outdoors there when it is dry & windy.
Stay out of and away from hot tubs, which can be a MAC-rich spot.
Use whole house and room HEPA air purifiers and change filters even more often than specified.
Stay away from people with respiratory infections, wear an N95 mask if I have to be around them.
Turned up the water heater above 134F.

Here are things I have decided to live with:
Drink and cook with filtered tap water at home (unboiled) and bottled spring water elsewhere.
Shower with a rainwater showerhead (larger drops) but I don't disinfect it. In hotels, I run hot water for 3-4 minutes, then shower as briefly as I can.
Swim in the ocean and saltwater swimming pools. In lakes I make every effort to keep my head and face out of the water.
I continue to travel and eat out (very cautiously now, due to Covid.)

So far, so good. My lungs have remained stable after 21 months off antibiotics, with no evidence of current infection, in spite of quitting the drugs while still positive for MAC.

What is the main source of your feeling of paranoia? I really don't think it was Dr Falkinham's intention to frighten us.

Sue

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Sue, at the recent NTMir conference in Berkeley (last Wednesday and Thursday) Dr. Falkinham said that salt water pools were not safe from NTM because the concentration of salt was not high enough. You are doing well in spite of that, but thought you should know, and good for others to hear this as well.

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@bolso1
Thanks Armando for posting Dr. Falkinham's environmental info. Also @sueinmn, the info is dated 2021, do y'all or anyone know if there has been any revisions/addendums to Dr. Falkinham's info since this 2021 printing? Thanks. This is a great place for info!

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@paxmundi

Sue, at the recent NTMir conference in Berkeley (last Wednesday and Thursday) Dr. Falkinham said that salt water pools were not safe from NTM because the concentration of salt was not high enough. You are doing well in spite of that, but thought you should know, and good for others to hear this as well.

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Thank you - but recently, he said on NTMinfo.org, that outdoor pools are safe to use, he did not say they were free of NTM. His rationale was that the high rate of dilution of any NTM in the rising vapors made them an unlikely source of infection.
Here is what he said:
"First, outdoor streams, rivers, ponds and lakes will have aerosols with NTM, but the NTM cells are rapidly dispersed by the great volume of outdoor air. It is necessary to judge whether the risk of aerosolization and inhalation is high or low. Outside the risk is low; inside (indoor spa or indoor pool) the risk is high. Remember, infection is due to a combination of two factors: number of NTM in aerosols and duration of exposure. Sitting by a lake for a short while is probably safe, but sitting by a lake all day may put you at risk." (https://connect.ntminfo.org/discussion/evaporation-from-rivers-and-lakes)

I avoid all indoor pools, saunas, steam rooms and hot tubs because you can see the accumulation of droplets in the air. For similar reasons I avoid soaking in outdoor hottubs, but I do swim or exercise for short times in an outdoor pool or lake, then leave the immediate area.

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@tte

@bolso1
Thanks Armando for posting Dr. Falkinham's environmental info. Also @sueinmn, the info is dated 2021, do y'all or anyone know if there has been any revisions/addendums to Dr. Falkinham's info since this 2021 printing? Thanks. This is a great place for info!

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It's the latest info now as far as I can tell - maybe someone has time to do a deeper dive?

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