If I Had A Million Dollars

Last week I started my blogs with a Barenaked Ladies song and it made me look up my old discs and this song came to mind

It would make my life easier if I did but it would not cure this awful illness.  There are some things money can’t buy.  I was thinking what would I do with the money.  The first thing that came to mind would be to pay someone to drive me around.  I am the driver in the house and I know sometimes I don’t go out because I can’t be faffed.  I would meet up with more of the friends I have met through this illness.  I have got to know loads of people and I regard most of them, my friends, now not just acquaintances.  I meet them occasionally when we are all fit enough but if I have someone to drive me around I would pick them up and do a bit of fine dining.  We would have Aspergillosis Meetings in Michelin starred restaurants!  I would also chuck money towards research.  I don’t think it would last long in my pocket!  The imagination is running away with me again today.

aspergillosis poster + FIT logo1 JPEG

wad2019 at poster

Well, tomorrow is the big day and I am busy organising all the lovely selfie photos everyone has sent (it is not too late) and amazing stories which I intend flooding social media with tomorrow.  The stories are so interesting as it is quite staggering the number of people that get wrongly diagnosed at first but once on the correct treatment things improve.  That is why early diagnosis is paramount.

I have one more thing to add about my routine where my drugs are concerned.  My GP will not prescribe 2 of my medications Colomycin and Fungizone or all the other bits that go with it, water, sodium chloride, needles and syringes and a sharps bin.  So this is done separately.  It gets delivered to me every 2 months from a firm that is organised from Brompton Hospital.  Nine times out of ten it is a brilliant service so can’t complain but I have a cupboard of drugs and now have a spare fridge as the Fungizone has to be refridgerated.  I have also invested in a small portable fridge if we go away for a weekend or something similar.  With sorting medication and hospital visits, 2 lung doctors, bone man, heart, eyes and diabetes my life does revolve around being ill no wonder sometimes I can’t be faffed to go out.

Sounds very depressing but the majority of the time it is routine so I don’t notice it much of the time and even though most of the people I talk to daily have aspergillosis they are from all walks of life and we seem to have so much talent between us.  Pharmacists, Horticulturists, scientists, it shows that Aspergillosis isn’t proud where it shows it ugly head.  All these lovely friends have turned their hands at other things when unable to work.  So many crafty people, writers, further education, singing.  It goes to show what a determined bunch we are.  So even though this illness can take over our lives we don’t waste a minute of it.

Join us tomorrow and spread the word.

Take care. x

http://www.aspergillosistrust.org

#WorldAspergillosisDay

Support flooding in

The Aspergillosis Trust has been collecting selfies from people, some you may recognise, holding the Aspergillosis Trust SelfieCard.

Many of these people are patients & carers, some are actors from TV soaps such as Coronation Street (ITV, Manchester UK) or well-known TV gardeners such as Alan Titchmarsh. One is a TV Dr- science communicator, another is an Olympic athlete on Team GB!

Whoever they are they are all playing a role in the vitally important work that the Aspergillosis Trust is carrying out on behalf of patients & carers and the Fungal Infection Trust.

Take a look at their gallery here and see who you can spot!

Better still – download the card and send in your selfie

Aspergillosis through the eyes of a child

Kate has aspergillosis and like many other patients with a form of chronic aspergillosis, she has to follow a daily routine of medication preparation and consumption. Kate’s granddaughter is amazing at helping her Nanny.

Kate and Grandaughter

If you haven’t got aspergillosis or other incurable chronic disease or you don’t live with someone who does you really should watch this short video as it will bring to your realisation the sheer amount of preparation and work it takes just to manage your medication every single day. Then consider the impact all those medications have on Kates health, commonly making her feel nauseous, cough uncontrollably, lose weight quickly, or put on weight, make all movement difficult and exhausting or just make her so fatigued it is a huge effort of will just to get out of bed.

People with aspergillosis can have all of those symptoms – and those are the good days!

During a flare-up of ABPA or when their lungs get an infection on top of the aspergillosis, they may have to take large amounts of antibiotics or even be admitted to hospital for a few days to have liquid antibiotics administered directly into the bloodstream. Or some people with aspergillosis experience bleeding from their lungs, coughing up hundreds of millilitres of blood in an episode.

Aspergillosis is a tough disease to live with. #WorldAspergillosisDay

 

Leslee’s Story – A Life with Aspergillosis

I smiled when Jill Fairweather asked us to write a few words on how aspergillosis affects us. I am sure most of us could write a novel on the effects it has had on our lives, before and after being diagnosed. I could write a novel on applying, fighting and winning my personal independence payment (PIP) allowance with this disease alone.

Before I was diagnosed, I thought I had lung cancer. It has been five years since the start of my symptoms and about two and a half years since being positively diagnosed with allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). Worst part for me was the initial feeling of isolation and loneliness. I didn’t know anyone else who had this disease. My GP didn’t know anything about it, my friends had never heard of it. After a few months the phone calls to go to different events in my local area began to stop. I would say I could go and then on the actual day feel so unwell I used to cancel. So after lots of cancellations the requests to go became fewer and fewer.

I had to have a stair lift fitted because I was too breathless to climb the stairs. I experienced numerous episodes of bleeding from the lungs, two of them were life threatening. I was on 40mg prednisone daily and put on four stone. I had become very withdrawn. Apart from GP, respiratory appointments or hospital inpatient stays I didn’t go anywhere. I had become very frustrated and angry because I couldn’t get any answers as to what was wrong with me.

Since being diagnosed and put on the right medication for me personally, I have got my life back. Yes, I have bad days, i.e. pneumonia last year and more recently a collapsed lung but I can breathe, I can go out, I can socialise, I can exercise.

I know I am one of the lucky ones with this disease who has had some remission from it. I had tried voriconazole, but I was still getting bleeding and other side effects. Once under Professor Denning’s care my medication was changed to posaconazole, I stopped the prednisone gradually and went on a 6 week pulmonary rehabilitation course. I have since lost the four stone I put on, partly through diet and partly by exercising.

I also have a wonderful and understanding respiratory consultant who referred me to Professor Denning. I wasn’t keen to go as it is a 600+ mile round trip for me, but I am now so happy that I made the decision to attend the National Aspergillosis Centre (NAC) in Manchester.

I know for some Aspergillosis can be successfully managed, I am one of those. When I see how far we have come with raising awareness of this condition, from the five years that I first started with the symptoms, it is amazing. Who would have thought that we’d have an Aspergillosis Awareness poster on the back of some London buses for World Aspergillosis Day on 1st February 2019?!

My hope/dream is to arrive into A&E on one of my bad flare-ups and when they ask me what is wrong and I reply ‘Aspergillosis’, nobody asks me “what is that?”…

@aspertrust
#WorldAspergillosisDay

Better diagnostics with minimal equipment

In many parts of the world there is poor diagnosis of fungal infections. Part of the problem is a lack of expertise and equipment in the many diagnostic labs that already exist and in some there is a lack of a reliable electricity supply so sophisticated machines are not going to help the situation. This is a significant barrier to getting the right treatment to many millions of people worldwide.

The Fungal Infection Trust has designed and built a series of online courses that are intended to train people to diagnose all fungal infections using nothing more than a light microscope and a few simple stains.

A microscopy training course for mycologists in 4 key modules.

Microfungi.net is a series of four modules translated into four languages (English, Spanish, Portuguese and French) with more to come in Chinese. Participating is free of charge and qualifies the participant to receive a certificate accredited by the University of Manchester, UK.

Module 1 – Teaches basic microscopy, stain preparations and staining techniques

Module 2 – How to use basic microscopy methods on wet mounted samples from a wide diversity of human tissues

Module 3 – An introduction to Histology and identification of fungal elements in many human tissues

Module 4 – An advanced course to learn skills in microscopy and histology for the identification of uncommon and very rare fungal pathogens

This course has been available for 18 months and hundreds of people have visited the site and started a course, but much more needs to be done and many more people need to become aware of this resource.
In addition large parts of the world do not speak any of the languages we have mentioned so far, so we need to add more translations to make this valuable resource more widely available.

New Genetics

The National Aspergillosis Centre and the Manchester Fungal Infection Group (MFIG) are at the forefront of the investigation of why some people get chronic aspergillosis when most of use do not. We are all breathing the same air and the source of the infection can only be the fungal spores in the air as most infection affect the lungs and sinuses!

Genetic studies looking at the entire genome of groups of patients who have chronic aspergillosis have started to reveal a small group of genes that seem to be consistently associated with aspergillosis. Perhaps unsurprisingly many of these appear to play a part in different parts of our defence mechanisms to resist infection. Fungi offer particular challenges for our bodies to solve – they are made up of strong threads that can force their way through membranes that would stop a bacterium for example, and fungal threads (hyphae) are far to large for a single neutrophil to engulf.

A recent study released by MFIG & NAC characterised a single gene named ZNF77 which, when carrying a particular mutation, causes Aspergillus fumigatus spores to stick more easily and strongly to the walls of an airway, and to germinate and grow faster! It isn’t difficult to realise that people carrying such a mutation will be more vulnerable to infection by Aspergillus, however even that change on its own is not thought to be enough to cause CPA or ABPA. There is much more to learn but it could certainly be useful to screen people thought to be at risk of chronic aspergillosis for this mutation. If someone has the mutation doctors could provide increased protection e.g. by giving antifungal drugs prior to and during a planned medical procedure such as a transplant.

#WorldAspergillosisDay

New Diagnostics

It is highly important that we are able to diagnose someone with aspergillosis as quickly as possible as the outcome of treatment is improved if we can begin earlier. Currently diagnosis is a complicated process that takes up a lot of time and that has a particular impact on people who have an acute invasive aspergillosis as that infection can progress rapidly, however there is also a large population of people who have chronic forms of aspergillosis such as Chronic Pulmonary Aspergillosis (CPA) and Allergic Pulmonary Aspergillosis (ABPA) and it is likely that many cases of severe asthma (SAFS) are also caused by Aspergillus sensitisation.

People who have chronic forms of aspergillosis are typically very difficult to diagnose. Centres such as the National Aspergillosis Centre (NAC) in Manchester are dedicated to detecting aspergillosis in patients who are struggling to manage severe asthma for example. Doctors throughout the UK send their patients to NAC as there is no local expertise, a situation that is repeated in many countries throughout the world. Only the worst patients tend to be referred, many fewer than predicted numbers of how many people there should be with ABPA/SAFS and other chronic aspergillosis in the UK. A simple test is badly needed to identify the ‘missing patients’, a test that must be sensitive and simple to use.

LD Bio, a company based in Lyon, France have developed a solution that may have far reaching consequences. Using this device doctors at the bedside of a patient who they suspect may have chronic aspergillosis can now simply put a drop of blood into the sample well at the top of the device and wait for a few minutes for the result to develop. If the patient has aspergillosis two bands will appear, if not one band will appear.

The National Aspergillosis Centre in Manchester, UK has tested the device (results to be presented at ECCMID 2019 in April 2019)  and found it to be accurate, identifying 91% of cases of Chronic Pulmonary Aspergillosis in 30min. The manufacturers claim that this test is equally as useful to detect cases of Allergic Bronchopulmonary Aspergillosis (ABPA) and Aspergillus colonisation, suggesting that many more ‘missing’ patients could now be identified quickly and cheaply. If the same technology could be used to detect cases of SAFS then even more patients could receive the correct treatment more quickly.

The test is cheap and accurate enough to use when resources are low (potentially even in developing countries) and a rapid result is desired.

 

The Impact of Aspergillus Worldwide

Research on Aspergillosis is gradually revealing that the fungus Aspergillus reaches into far more of our lives that we previously thought. Far from earlier assumptions that our airways are usually sterile places that contain no microbes, the latest research suggests that Aspergillus and many other microbes reside in many of our lungs as part of our normal micro/mycobiome and causes no health problems at all.  In fact many bacterial & fungal species found in our microbiome are thought to protect us from infection by pathogens. This harmless growth is sometimes referred to as colonisation.

Paradoxically there are large numbers of people in the world who have serious fungal infections caused by Aspergillus colonisation of their airways and lungs which suggests that either something is different about the fungus or the infected person in each case.

In some cases the cause is clearer for example someone who receives a transplant (solid organ or bone marrow) usually experiences a period of several days when they are less able to fight off infections. People who have an impaired immune system due to having AIDS are similarly affected (estimated 300 000 cases of invasive aspergillosis worldwide). Those people are often kept in sterile rooms until they recover enough of a functional immune system to cope with our normal air which contains many potential pathogens. Despite these precautions some will get an infection such as aspergillosis and it is easy to speculate that such cases may be caused by an Aspergillus pathogen  that had up to that point been harmlessly colonising their lungs.

What then of people with severe asthma with fungal sensitivity (SAFS: 6.5 million cases worldwide) who have a fungus growing in their lungs and they have become sensitive to its allergens, exacerbating their respiratory symptoms? How are they different to other asthmatics and non-asthmatics?

There are also 3 million cases of Aspergillus slowly eroding cavities into the lungs of people who apparently have a normal immune system (Chronic Pulmonary Aspergillosis CPA). Why are they so infected when many more have Aspergillus growing in their lungs with no ill effects?

We need to be able to identify individual at risk from infection as early as possible so that treatment outcomes are the best possible. To do that we need to understand why some people become infected or sensitised when most do not even though they have Aspergillus growing in their lungs.

World Aspergillosis Day is a great time to think about helping the Aspergillosis Trust and the Fungal Infection Trust fund more research into aspergillosis.

#WorldAspergillosisDay

Aspergillosis Trust Activities WAD 2019

#WorldAspergillosisDay

Aspergillosis Trust Activities

The Aspergillosis Trust has several activities planned for WAD 2019, one of which is already in operation!

This banner features two of their patrons; Dr Emily Grossman and Alan Titchmarsh and can be seen on the back of 15 buses in the Hyde Park/South Kensington/Fulham/Richmond Park area of London, which includes a route going past the Brompton Hospital. The buses will run throughout January 2019 up to Feb 1st, World Aspergillosis Day itself.