Friday, July 31, 2009


The pulmonary specialist thought Fred might be aspergillosis

He ordered a blood test. I'm at risk because I have asthma. The fevers could be a symptom of aspergillosis. The Bronchoscopy washings were negative for aspergillosis and so was a follow up blood test.

Aspergillosis is a group of illnesses caused by mold. The mold that triggers the illnesses, aspergillus, includes more than 150 types of mold that occur widely in the indoor and outdoor environment. Although most of the molds are harmless, a few can cause serious illnesses in people with a weakened immune system, underlying lung disease or asthma. These illnesses, collectively called aspergillosis, range from allergic responses to severe and sometimes fatal infections.

Aspergillosis begins when susceptible people inhale mold spores into their lungs. In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most serious form of aspergillosis — invasive aspergillosis — occurs when the infection spreads to blood vessels and beyond, into the lungs to other organs.

The name of the fungus, Aspergillosis, was coined by a priest botanist, for its resemblance to the aspergillum, a brush used for sprinkling holy water in the Catholic high masses. Over 135 species have been described. A couple dozen are involved in human and animal disease.

Depending on the type of aspergillosis, treatment may involve watchful waiting, antifungal medications, steriods or, in rare cases, surgery.

Diagnosing aspergillosis can be difficult. Aspergillus is common in the environment and is sometimes found in the saliva and sputum of healthy people. What's more, it's hard to distinguish aspergillus from other molds under the microscope, and symptoms of the infection are similar to other conditions.

To arrive at an accurate diagnosis, your doctor is likely to use one or more of the following tests:

  • Imaging tests. A chest X-ray or computerized tomography (CT) scan — a type of X-ray that produces more detailed images than conventional X-rays do — can usually reveal an aspergilloma as well as characteristic signs of invasive and allergic aspergillosis.
  • Sputum stain and culture. In this test, a sample of your sputum is stained with a dye and checked for the presence of aspergillus filaments. The specimen is then placed in something that encourages the mold to grow.
  • Tissue and blood tests. Diagnosing allergic bronchopulmonary aspergillosis usually requires skin and blood tests. For the skin test, a small amount of aspergillus antigen is injected into your forearm. If you have antibodies to the mold in your bloodstream, you'll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies, indicating an allergic response.
  • Biopsy. Examining a sample of tissue from your lungs or sinuses under a microscope is usually necessary to confirm a diagnosis of invasive aspergillosis.
I've had all these tests except Sputum, none of them positive for the fungi, but that's still not conclusive that I don't have it. It might not be aspergillosis -- it might be cancer. Or... something else?

Thursday, July 30, 2009

What Next?

I think I'm going to drive out to Bolinas to
a cancer retreat center which has a good
library. They balance western and alternative
ideas and I need the alternative voice in
my head. I also ordered some books on
lung cancer from the library tonight

This surgeon and the pulmonary specialist
felt much too much like a railroad train taking
me somewhere I don't know. I didn't trust

That means I have to become more familiar with
this unusual place -- the country of the major
lung problem.

Wednesday, July 29, 2009

off to see the lung surgeon

My visit with the lung surgeon today was pretty horrible.
He thinks we should just cut out my right middle lobe
if the mysterious thing hasn't cleared up.

Whether it's inflammation, fungus or cancer,
it's all to the good to take out some of my lung out (in his
opinion). Which I think is ridiculous.

On the not-ridiculous side, lung cancer has a very
low survival rate and this is likely the only way to catch it
when it's too small to see on tests and hasn't spread.

Oh... but ... maybe there's no cancer in there...

Shsssssh. I'm starting to do my own research and
I will set up a 2nd opinion. In the meantime, the
fungal test #1 should be showing up with results.

I'm starting in the middle of this. If you've just joined
me, come back. I'll post more of the back story as the
days go by. The short explanation is that I had something
(a contour? a collapse, a constriction?) show up in June
in a CT scan of my lungs. We're now searching for a
diagnosis. We are deep in the woods, feeling all
poked and prodded and no clear path has emerged.