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She had been coughing for two years. The cause was a surprise.

The voice on the phone was clear and efficient. The 75-year-old woman listened, speechless. Her much-anticipated surgery to repair the crumpled vertebra in her lower back has been canceled. The caller informed her that her chest X-ray, a routine pre-surgery test, was abnormal. She should consult her doctor and, when her x-ray is normal, she could postpone the operation. She elicited a polite response and hung up. She felt her heart racing and sat up.

She had been coughing for two years. It began shortly after the pandemic descended on New York City and the length of Long Island, even in the sleepy village of Quogue where she had moved at the end of a busy career in Manhattan. After working for several weeks – longer than any normal cough should last – she went to see her GP. The doctor immediately tested her for Covid and sent her for an X-ray. When both were normal, both doctor and patient were reassured. Her doctor suggested she get rid of her feather pillows and down comforter, in case they caused an allergic reaction, and she did so. That didn’t help. Sometimes she considered going to town to see a pulmonologist, but knew the doctors there would be drowning in Covid cases. People were dying and she only had a cough.

But a year and a half later, she was still coughing. He was her constant companion, with her all day, and according to her daughter – who came back to live with her when the pandemic hit – he was also there all night. And it was a disgusting cough, like she was coughing up something horrible. Worse still, over the last few months, she noticed that exercise was more difficult. She was a great walker – she and her dog could walk for miles on the beach and through the village. Now, even a short walk could leave her out of breath. Not out of breath, but out of breath like she’d never been from just walking. Sometimes just making her bed made her breathe a little harder than she should. Sure, she was 75 years old, but she was in good health. At least, she thought so.

It was when she noticed she had lost weight – more than 20 pounds – that she became concerned. That’s when she went to see an ear, nose and throat specialist, who examined her and put a camera down her throat. Everything looks good, he told her. He thought it might be reflux and prescribed heartburn medication. As that didn’t help her either, she let it go.

But now, a few months later, that routine x-ray showed there was a problem with his lungs. She called her doctor back. The doctor reviewed the x-ray and immediately ordered a CT scan of the woman’s chest. The results were posted in his electronic medical record that same day. The patient examined them anxiously. She didn’t understand much of the language, although it was clear the scan was not normal. She used the Internet to try to understand what she was reading. Every page she read led to more searches and newer, stranger terms. Did she have interstitial lung disease? And what exactly was it? Finally, she found a sentence that ended her search: “The most common form of interstitial lung disease, idiopathic pulmonary fibrosis (IPF), has a life expectancy of approximately three to five years. »

Terrified, she called her former doctor, who had cared for her for years when she lived in New York. “Am I going to die in three to five years? she asked him, as calmly as she could. She read the scan results to the doctor. She, too, was concerned about the radiologist’s findings and suggested the patient see a pulmonologist. She knew a good one: Dr. Lester Blair of Weill Cornell Medicine in New York. The older woman thanked her, then immediately called her office. She got an appointment for the following week.

It was a cold, crisp February day when the patient drove to the Upper East Side to see Blair. The doctor knocked on the examination room door, then entered quickly. He was tall and thin and appeared to be in his sixties. He showed up and got to work. He asked: Do you have a bird? She was stunned by the question. Why on earth would that matter? And how did he know? Because actually, she did. Or rather, his daughter did. She brought a parakeet home when she moved in at the start of the pandemic. Blair nodded. And who took care of the bird? Well, she did. She had birds years ago and loved taking care of them. She changed the food and water and cleaned the cage every day. She did the same for the birds that visited the feeders outside her windows. Blair nodded again.

It’s possible that her daughter’s bird was causing the cough, Blair said. It’s possible she developed a type of bird allergy called hypersensitivity pneumonitis, a variation of which is known as bird lovers’ lung. It was first identified in 1965 among pigeon breeders, but is now recognized as one of the most common causes of this type of lung disease, likely affecting thousands of bird owners. But there were other possibilities they should test her for as well. In the meantime, she should consider finding a new home for the bird and having her house cleaned to remove any allergens remaining after the bird is gone.

After a brief examination, Blair sent her to the lab, where tubes of blood were drawn. She was scheduled to follow up with one of her colleagues, Dr. Kerri Aronson, a pulmonologist who specializes in this type of lung disease.

The bird was still living with the woman when she returned to Aronson. When the doctor showed up, the patient repeated the story one more time. The cough started a few months after the bird arrived. She had had birds before and this had never happened. But, she added, she took Blair’s advice and the bird would go to a new home in a few weeks. Aronson then asked him about other possible exposures. Had she ever smoked? No. Had her house suffered water damage or a mold problem? Never. Did it have a jacuzzi? Had she ever lived on a farm? The list went on and on. She had none of these exposures. Just the bird.

Blair had tested the woman for signs of sensitivity to various bird allergens. They were all negative. Was it really the bird? He also ordered tests to look for other causes of this type of lung disease. Nothing appeared there either. So what was it? Despite the negative tests, Aronson still believed the bird was the most likely culprit. But he still had one more test to do before starting treatment: a test to examine his lungs from the inside. During this procedure, a small camera would be inserted into his lungs. A sterile liquid would be sprayed into the airways and then suctioned out. The recovered fluid would be examined for signs of inflammation and for any viruses or other insects.

This test, called bronchoalveolar washing, was performed 10 days later. The fluid sucked from his lungs was full of inflammatory cells. But there was no virus. No bacteria. No mushrooms. With everything else ruled out, Aronson began giving the patient a high dose of prednisone to calm what still seemed most likely to be an allergic inflammatory process. The prednisone was like magic. Almost immediately, the patient noticed that her cough had calmed and her breathing was easier. When she returned to see Aronson two months later, she felt good. She still coughed from time to time, but it was steadily getting better. The scans took longer to improve, but the most recent one, this spring, showed only a scattering of abnormal spots, which are likely scars.

I asked Aronson about the inconclusive test results. She said the patient’s history of a cough that started months after the bird arrived, as well as the typical CT scan, seemed more important than the test results. And its improvement once the bird left the house was reassuring. No test is perfect, she reminded me.

The patient is delighted to have finally been able to have the much-needed back surgery – and to be able to enjoy her walks again. She doesn’t do the kind of mileage she did before the bird moved in – but she and her dog are a few years older. And while they walk, they always like to watch and listen to the birds, from a very safe distance.

News Source : www.nytimes.com
Gn Health

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