Re:Went to Pul doc this a.m. and had thorough pul......

[Guest guest]

Steve,

Research that methacholine test before you submit - my doc told me not to let

anyone give me one because it could be dangerous. Also, had a high resolution

CT scan of lungs, doc says it shows more than a standard X-ray - and it did.

Another test result was that oxygen diffusion, the oxygen that transfers from

the lungs to the blood stream, was low. I don't remember which test showed that

result. The standard blood oxygen test didn't show any problem, but the

diffusion capacity testing did.

Sorry to make this more complicated, but if your doc doesn't know about mold he

may try to use standard testing to find results that won't show up there. I give

him points for trying and not wanting to prescribe you anti-anxiety or

depression drugs!

This is the problem of lack of information for general practice doctors. Even

if they believe you about your illness, they don't know how to approach it.

(This is the main reason I started the 'Impact of Mold Illness Petition " , so we

can create the awareness needed to get the word out so they will learn how to

help us).

Sue

[Guest guest]

Hi ,

Test you took shows slow rate of oxygen going

from your lungs to your bloodstream? How does

that impact you?

Also you said high resolution catscan was better

than standard xray, do you mean standard catscan

versus high resolution catscan or are you really

meaning a catscan versus a regular standard xray?

[Guest guest]

<Hi ,

Test you took shows slow rate of oxygen going

from your lungs to your bloodstream? How does

that impact you?>

Hello Barb, I think it is a factor in feeling short of breath and fatigued,

along with other circulation issues. My theory is that the reduced oxygen

combined with VOC's inhaled results in MCS symptoms.

<Also you said high resolution catscan was better

than standard xray, do you mean standard catscan

versus high resolution catscan or are you really

meaning a catscan versus a regular standard xray?>

Better than both reg. CT & reg. X-Ray- I used to have a research paper

bookmarked - 2 computer crashes ago! I will try to find it and post.

[Guest guest]

Sue,

I have an Rx for a catscan with contrast since last summer...I don't

always take them right away. Do you think I can take Rx for catscan

to a high resolution scanner? I have heard of these and my only

thought is that it probably exposes one to more radiation. However

maybe one good one may be better reveal problem and you will not need

a get another one.

--- In , Sue ston <thecanaries@...>

wrote:

>

> Better than both reg. CT & reg. X-Ray- I used to have a research

paper bookmarked - 2 computer crashes ago! I will try to find it and

post.

>

[Guest guest]

Do it with a high density resolution cat scanner. It will save having to do it

all over again. The more cuts or slices, the better. Also have it looked at a

facility who has a radiologist who specializes in your area of concern. In my

experience, a general radiologist is not as good for lung problems as some one

who is a radiologist who only looks at lung cts. Jane Ann

barb1283 <barb1283@...> wrote: Sue,

I have an Rx for a catscan with contrast since last summer...I don't

always take them right away. Do you think I can take Rx for catscan

to a high resolution scanner? I have heard of these and my only

thought is that it probably exposes one to more radiation. However

maybe one good one may be better reveal problem and you will not need

a get another one.

>

> Better than both reg. CT & reg. X-Ray- I used to have a research

paper bookmarked - 2 computer crashes ago! I will try to find it and

post.

>

---------------------------------

Access over 1 million songs - Music Unlimited.

[Guest guest]

Barb,

I am pretty sure you cannot use your script for the Hi Res CT scan - since it is

actually a different test, just like you can't use an X ray script to get a CT

scan. I don't know if every facility has a high res ct scanner, and it probably

is more expensive. I found my info, here is an excerpt and link to the full

article - it is on ideopathic pulmonary fibrosis (interstitial lung disease and

hypersensitivity pneumonitis are included in this article). It does say that

even with the higher sensitivity of the test, hypersensitivity pneumonitis

sometimes does not show even on the High Res scan - so normal scan doesn't

necessarily mean no problem.

http://ajrccm.atsjournals.org/cgi/content/full/161/2/646

<High Resolution CT Scanning

High-resolution CT (HRCT) scanning has changed the diagnostic

evaluation of patients with IPF (72, 80, 81). The technique of high-resolution

CT allows detailed evaluation of the lung parenchyma by using 1- to 2-mm-thick

slices, with a reconstruction algorithm that maximizes spatial resolution.

HRCT allows earlier diagnosis of IPF, helps to narrow the differential diagnosis

based on the CT pattern, and allows the identification of the extent of

associated emphysema (72, 82, 83). HRCT can also help to increase the level of

diagnostic confidence for IPF, when the clinical or radiologic features are

uncertain.

<>

Accuracy of HRCT diagnosis. Studies that have evaluated the

ability of CT scanning to accurately diagnose IPF have found that CT increases

the level of diagnostic confidence compared with the chest radiograph. The

accuracy of a confident diagnosis of UIP made on HRCT by a trained observer

appears to be about 90% (75, 84). However, because a confident diagnosis of IPF

is made by HRCT evaluation in only about two-thirds of patients with histologic

UIP (85), about one-third of cases of UIP will be missed by relying on CT

diagnosis alone. Less experienced observers are substantially less accurate than

experienced observers (75).

Differential diagnosis of the HRCT pattern. Connective tissue

diseases (particularly scleroderma and rheumatoid arthritis) (86, 87) and

asbestosis (88) are commonly similar in CT appearance to IPF, except for the

presence of parenchymal bands of fibrosis and pleural plaques in patients with

asbestosis. Patients with subacute or chronic hypersensitivity pneumonitis can

have similar reticular opacity or honeycombing, but often lack the bibasilar

predominance seen in IPF (84). IPF may also be mimicked on CT by sarcoidosis

(92) or idiopathic BOOP (77).

Extensive ground glass opacity on CT of the lung ( 30% of lung

is involved) should prompt consideration of another diagnosis rather than IPF,

particularly desquamative interstitial pneumonitis (DIP) (93). Similar ground

glass opacification, without basal or peripheral predominance, may be found in

patients with respiratory bronchiolitis-interstitial lung disease (94),

hypersensitivity pneumonitis (84, 95), idiopathic BOOP (77), or nonspecific

interstitial pneumonia (NSIP) (96). The presence of centrilobular nodules,

middle and upper lobe lung predominance, and absence of honeycombing favor

hypersensitivity pneumonitis over IPF (84). Most importantly, the CT features

must be interpreted in conjunction with a complete clinical evaluation.

<>

Role of HRCT in defining disease extent. CT is

increasingly used for quantification of disease extent. Subjective,

semiquantitative assessment of disease extent by CT shows moderate interobserver

variability. This semiquantitative assessment correlates with evidence of

physiologic impairment (104, 105). One study showed that the extent of overall

lung involvement and the extent of ground glass pattern in the HRCT scans show

a moderate correlation only with FVC and arterial PO2 at peak exercise (103).

Use of parameters derived from the digital CT data set may provide a more

objective measure of disease extent (106).

For detection of early or mild infiltrative lung disease, HRCT

is clearly more sensitive than the chest radiograph (107). However, in the early

stages of any lung disease, including IPF, the degree of parenchymal

infiltration may be too slight to cause any CT abnormality (72). Indeed, it has

been shown that patients with biopsy-proven hypersensitivity pneumonitis (107),

sarcoidosis (108), asbestosis (109), and IPF (72) may have normal

high-resolution CT studies. Therefore, although it is quite rare, a normal HRCT

cannot be used to exclude infiltrative lung disease.>

[Guest guest]

Sue--Thanks much for the informative post re: fibrotic changes. my ct most

recently shows some minor fibrotic changes. I told this to the pulmonologist

but he did not seem concerned. well, no wonder I have the odd sensation of

" rocks " in my lower lungs.

They have fossilized.

Jane Ann MOSHER

Sue ston <thecanaries@...> wrote:

Barb,

I am pretty sure you cannot use your script for the Hi Res CT scan - since it is

actually a different test, just like you can't use an X ray script to get a CT

scan. I don't know if every facility has a high res ct scanner, and it probably

is more expensive. I found my info, here is an excerpt and link to the full

article - it is on ideopathic pulmonary fibrosis (interstitial lung disease and

hypersensitivity pneumonitis are included in this article). It does say that

even with the higher sensitivity of the test, hypersensitivity pneumonitis

sometimes does not show even on the High Res scan - so normal scan doesn't

necessarily mean no problem.

http://ajrccm.atsjournals.org/cgi/content/full/161/2/646

<High Resolution CT Scanning

High-resolution CT (HRCT) scanning has changed the diagnostic evaluation of

patients with IPF (72, 80, 81). The technique of high-resolution CT allows

detailed evaluation of the lung parenchyma by using 1- to 2-mm-thick slices,

with a reconstruction algorithm that maximizes spatial resolution. HRCT allows

earlier diagnosis of IPF, helps to narrow the differential diagnosis based on

the CT pattern, and allows the identification of the extent of associated

emphysema (72, 82, 83). HRCT can also help to increase the level of diagnostic

confidence for IPF, when the clinical or radiologic features are uncertain.

<>

Accuracy of HRCT diagnosis. Studies that have evaluated the ability of CT

scanning to accurately diagnose IPF have found that CT increases the level of

diagnostic confidence compared with the chest radiograph. The accuracy of a

confident diagnosis of UIP made on HRCT by a trained observer appears to be

about 90% (75, 84). However, because a confident diagnosis of IPF is made by

HRCT evaluation in only about two-thirds of patients with histologic UIP (85),

about one-third of cases of UIP will be missed by relying on CT diagnosis alone.

Less experienced observers are substantially less accurate than experienced

observers (75).

Differential diagnosis of the HRCT pattern. Connective tissue diseases

(particularly scleroderma and rheumatoid arthritis) (86, 87) and asbestosis (88)

are commonly similar in CT appearance to IPF, except for the presence of

parenchymal bands of fibrosis and pleural plaques in patients with asbestosis.

Patients with subacute or chronic hypersensitivity pneumonitis can have similar

reticular opacity or honeycombing, but often lack the bibasilar predominance

seen in IPF (84). IPF may also be mimicked on CT by sarcoidosis (92) or

idiopathic BOOP (77).

Extensive ground glass opacity on CT of the lung ( 30% of lung is involved)

should prompt consideration of another diagnosis rather than IPF, particularly

desquamative interstitial pneumonitis (DIP) (93). Similar ground glass

opacification, without basal or peripheral predominance, may be found in

patients with respiratory bronchiolitis-interstitial lung disease (94),

hypersensitivity pneumonitis (84, 95), idiopathic BOOP (77), or nonspecific

interstitial pneumonia (NSIP) (96). The presence of centrilobular nodules,

middle and upper lobe lung predominance, and absence of honeycombing favor

hypersensitivity pneumonitis over IPF (84). Most importantly, the CT features

must be interpreted in conjunction with a complete clinical evaluation.

<>

Role of HRCT in defining disease extent. CT is increasingly used for

quantification of disease extent. Subjective, semiquantitative assessment of

disease extent by CT shows moderate interobserver variability. This

semiquantitative assessment correlates with evidence of physiologic impairment

(104, 105). One study showed that the extent of overall lung involvement and the

extent of ground glass pattern in the HRCT scans show a moderate correlation

only with FVC and arterial PO2 at peak exercise (103). Use of parameters derived

from the digital CT data set may provide a more objective measure of disease

extent (106).

For detection of early or mild infiltrative lung disease, HRCT is clearly more

sensitive than the chest radiograph (107). However, in the early stages of any

lung disease, including IPF, the degree of parenchymal infiltration may be too

slight to cause any CT abnormality (72). Indeed, it has been shown that patients

with biopsy-proven hypersensitivity pneumonitis (107), sarcoidosis (108),

asbestosis (109), and IPF (72) may have normal high-resolution CT studies.

Therefore, although it is quite rare, a normal HRCT cannot be used to exclude

infiltrative lung disease.>