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 work with my primary, ID doc and pulmo. Believe it or not, they collaborate and all are watching me, so I'm confident.
Sue

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I didn't mean it as a criticism. But I'm sensitive about sputum samples.

I have had nodules appear pretty much throughout my lungs along with mucus plugs, groundless opacities and on and on since 2010. The nodules are "followed" with frequent ct scans to see if they grow or disappear. Radiologists began reporting that the nodules may be bacteria or they may be aspirations because I have a small hiatal hernia and a widened esophagus (patulous). In 2018, the radiologist named the suspected bacteria as possible mycobacteria. I researched it and at my pulmonary appointment asked my pulmonogist if we should do a sputum sample to check it out. I had brought in samples when I was diagnosed with bronchiectasis in 2011 but none since then. She said that she was sure it was aspiration. When I pushed for the sample, she said, "I can read a ct scan. It's aspiration."

I couldn't understand her reluctance and thought she should have more respect for the radiologist. After all his career is spent reading ct scans.

Anyway I changed pulmonologists and at the first appointment with my new one she ordered sputum sampling which came back positive for MAC.

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@rits

I didn't mean it as a criticism. But I'm sensitive about sputum samples.

I have had nodules appear pretty much throughout my lungs along with mucus plugs, groundless opacities and on and on since 2010. The nodules are "followed" with frequent ct scans to see if they grow or disappear. Radiologists began reporting that the nodules may be bacteria or they may be aspirations because I have a small hiatal hernia and a widened esophagus (patulous). In 2018, the radiologist named the suspected bacteria as possible mycobacteria. I researched it and at my pulmonary appointment asked my pulmonogist if we should do a sputum sample to check it out. I had brought in samples when I was diagnosed with bronchiectasis in 2011 but none since then. She said that she was sure it was aspiration. When I pushed for the sample, she said, "I can read a ct scan. It's aspiration."

I couldn't understand her reluctance and thought she should have more respect for the radiologist. After all his career is spent reading ct scans.

Anyway I changed pulmonologists and at the first appointment with my new one she ordered sputum sampling which came back positive for MAC.

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I wasn't taking it as a criticism because I know not every doc is as good as my team. I am watched "like a hawk", especially by my primary of over 20 years. She must have a "flag" on my electronic chart, every time I see a different doc, she either messages or calls to see how it went, whether I feel I'm getting good care, etc.
Everyone should be as fortunate.
Sue

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@sueinmn

I wasn't taking it as a criticism because I know not every doc is as good as my team. I am watched "like a hawk", especially by my primary of over 20 years. She must have a "flag" on my electronic chart, every time I see a different doc, she either messages or calls to see how it went, whether I feel I'm getting good care, etc.
Everyone should be as fortunate.
Sue

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You are so very fortunate for the care you receive with your medical needs! This is not always the case for, I’m guessing, a number of us that live in places outside of major metropolitan areas. Our access to quality healthcare is limited; often mediocre (or less); and we travel very long distances and need to be self-determined; who are self-advocating, attempting to find resources, try not to give up, and really manage our own care. Each specialist works independently and our PCP is minimally involved. It is a challenging position to be in but it’s important to persevere for the best outcomes we can have.

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It saddens me to hear of these pulmonary doctors who are unwilling to listen to their patients. I think they let their pride or lack of experience get in the way of properly caring for their patient. I was diagnosed with MAC and pseudomonas in January 2019–by bronchoscopy and CT. I was started on the big 3 but had to stop after 6 weeks because I could not tolerate the side effects. I was told by the pulmonary doctor, "I may not be able to help you." He did not offer an alternative, referral, etc. Just sent me on my way with a hopless feeling. Once I found out about this forum I was able to find a specialist who had the qualifications to properly treat me. It has still been "rocky" at times with recurring pseudomonus and a couple of other bacterial infections but I was able to get through with careful monitoring and medications. We've heard it many times on Mayo Connect–don't give up and reach out. There is help and hope out there. God bless us all.

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@fdixon63

It saddens me to hear of these pulmonary doctors who are unwilling to listen to their patients. I think they let their pride or lack of experience get in the way of properly caring for their patient. I was diagnosed with MAC and pseudomonas in January 2019–by bronchoscopy and CT. I was started on the big 3 but had to stop after 6 weeks because I could not tolerate the side effects. I was told by the pulmonary doctor, "I may not be able to help you." He did not offer an alternative, referral, etc. Just sent me on my way with a hopless feeling. Once I found out about this forum I was able to find a specialist who had the qualifications to properly treat me. It has still been "rocky" at times with recurring pseudomonus and a couple of other bacterial infections but I was able to get through with careful monitoring and medications. We've heard it many times on Mayo Connect–don't give up and reach out. There is help and hope out there. God bless us all.

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I am beyond blessed to have the primary care provider I found 20+ years ago! She was a new Nurse Practitioner at the time, and her type of practice was new to our provider group. I was tired of searching for a doctor who would listen, research & reach out to other professional, and stick around.
I was so fortunate – we have been together through the aging process, she has also been the primary for both my daughters, and she has gone on add MS and PhD degrees in Nurse Practice, Gerontology, Women's Health…
Yesterday I contacted her regarding a concerning test result, at 9am today she was on the phone discussing it & making a referral for me.
She has given me the confidence to manage my own health care and has no qualms about telling me which specialists and facilities to choose or avoid.

I asked her why, with all the additional schooling, she did not become a physician – her response – NP's are given 20/40/60 minutes per appointment. For the same issue, physicians are given 10//20/30 minutes. She says "I can't practice good medicine that way." The gastro NP told me the same thing – she has twice as much time per patient as the doc – and the ability to "refer up" to the docs if the issue is beyond her expertise. Sure has changed my thinking about choosing who to see first!
Sue

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Thank you for sharing this article. I will not switch to an electric water kettle. I think the water kettles shut off right when it boils. I thought it needs to boil for 10 minutes to eliminate the NTM.

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@sueinmn

I am beyond blessed to have the primary care provider I found 20+ years ago! She was a new Nurse Practitioner at the time, and her type of practice was new to our provider group. I was tired of searching for a doctor who would listen, research & reach out to other professional, and stick around.
I was so fortunate – we have been together through the aging process, she has also been the primary for both my daughters, and she has gone on add MS and PhD degrees in Nurse Practice, Gerontology, Women's Health…
Yesterday I contacted her regarding a concerning test result, at 9am today she was on the phone discussing it & making a referral for me.
She has given me the confidence to manage my own health care and has no qualms about telling me which specialists and facilities to choose or avoid.

I asked her why, with all the additional schooling, she did not become a physician – her response – NP's are given 20/40/60 minutes per appointment. For the same issue, physicians are given 10//20/30 minutes. She says "I can't practice good medicine that way." The gastro NP told me the same thing – she has twice as much time per patient as the doc – and the ability to "refer up" to the docs if the issue is beyond her expertise. Sure has changed my thinking about choosing who to see first!
Sue

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@sueinmn She sounds great, I need one too! All the best with your test result referral.

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@valerie613

Thank you for sharing this article. I will not switch to an electric water kettle. I think the water kettles shut off right when it boils. I thought it needs to boil for 10 minutes to eliminate the NTM.

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I have looked high and low. In all the published material about NTM I cannot find any study saying definitively that it takes ten minutes of boiling to kill NTM. The best I could find was a recommendation in a single table in this article: https://www.atsjournals.org/doi/10.1513/AnnalsATS.201301-013FR
Logically, this recommendation just doesn't make sense to me. If NTM cannot grow in my water heater if I keep the temperature above 135F (or 70C), and the water heater never boils the water at all, it seems bringing the water to 212F (100C) for any length of time should get rid of any NTM.
So I challenge the research lovers here to find the source of this oft-repeated "boil 10 minutes" caveat. Even the EPA says clear water, as from a lake or stream, needs to be boiled for only 1 minute to remove all pathogens.

Sue

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@sueinmn

I have looked high and low. In all the published material about NTM I cannot find any study saying definitively that it takes ten minutes of boiling to kill NTM. The best I could find was a recommendation in a single table in this article: https://www.atsjournals.org/doi/10.1513/AnnalsATS.201301-013FR
Logically, this recommendation just doesn't make sense to me. If NTM cannot grow in my water heater if I keep the temperature above 135F (or 70C), and the water heater never boils the water at all, it seems bringing the water to 212F (100C) for any length of time should get rid of any NTM.
So I challenge the research lovers here to find the source of this oft-repeated "boil 10 minutes" caveat. Even the EPA says clear water, as from a lake or stream, needs to be boiled for only 1 minute to remove all pathogens.

Sue

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When I went to NJ they told me to boil the water for 10 minutes.

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@pop55

When I went to NJ they told me to boil the water for 10 minutes.

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But why 10 minutes? Even in their literature, I can't find any evidence that 10 minutes is required to kill NTM.
My reason for looking at this issue is that a number of people would like to use electric kettles to boil their water, but these shut off, or at least reduce the heat, after the water boils. Is that adequate to kill NTM and make the water safe?
Sue

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