Stuff I cut and pasted from the Guidance for Physicians regarding mold

[Guest guest]

Below I cut and paste some of the info that doctors are supposed to

do when you report illness accociated with mold. They certainly are

not supposed to ignore this situation. Good info. I have read up to

Page 51. I have more info that is related to symptoms I have on

record and are allergic related but very informative if you want more

that I cut and pasted.

A Public Health Model:

The Sentinel Case

Once a building relationship is established, the

healthcare provider is encouraged to exclude

a more general public health problem related

to the building. Without requesting names, the

provider should ask whether other individuals

in the building have similar symptoms.

In many states, physicians must report

occupational diseases of any type to the state

department of health or labor. In all states, if

multiple individuals are involved, the

conditions should be reported to the state

health department, and an industrial hygienist

or someone with experience in evaluating

buildings for building-related illnesses should

evaluate the building to identify the cause of

the illness. Sources of water intrusion and

mold amplification need to be identified and

recommendations for repairs need to be

made.

The toxicity of mold products in humans is best documented in

situations involving ingestion of

moldy foods, direct skin contact with concentrated toxins, and

inhalation of molds at very high concentrations.

In recent years, there have been numerous reports in both the medical

literature and the popular

media that indoor exposure to fungi or fungal toxins has caused

significant disease or death in the

occupants of water damaged homes or workplaces. These locations had

significant (generally visible)

fungal growth and odors, typically reported as from the " black mold, "

Stachybotrys chartarum. (It

should be noted here that many molds are " black " in appearance.) S.

chartarum is a ubiquitous organism,

growing on cellulose products exposed to water or high humidity. In

moist buildings, S. chartarum

frequently grows on wallpaper, wallboard, ceiling tiles, carpets

(especially those with jute backing),

insulation (e.g., urea–formaldehyde foam) in the spaces between inner

and outer walls, around leaking

window frames or water pipes, and in HVAC air ducts containing lint

or other organic debris.

While we focus on mold, we want to

emphasize that the risk factor clearly associated

with symptoms and illness is chronic or severe

moisture incursion into buildings with subsequent

growth of microbial agents. The potential

role of bacterial agents, dust mites, and pests associated with

moisture in buildings should not be

ignored.

Patients Whose Conditions Warrant an Environmental Assessment Because

They Are Frequently Induced by Environmental Factors, Including

Moisture and

Mold

Table A lists medical conditions that, in the absence of an

alternative explanation, should

prompt an environmental history especially with inquiries about

possible exposure to moisture and

molds. New onset and exacerbated asthma, interstitial lung disease,

hypersensitivity pneumonitis,

sarcoidosis, and pulmonary hemorrhage in infants are conditions that

can lead to chronic, progressive

disease or death if an etiologic agent is responsible and not

recognized. We also suggest that

healthcare providers consider pursuing an environmental history with

patients who have any of

the three precursor conditions listed on the right hand side of the

table: mucosal irritation, recurrent

rhinitis/sinusitis, and recurrent hoarseness. While they are in

themselves of less importance to

overall health, their presence in an individual who seeks care

because of exposures in an environment

of concern would warrant intervention to prevent progression to more

serious illness in the

future. If a patient has a condition listed in Table A, then the

physician may proceed to the questions

in Table C to explore possible environmental exposures.

A Note on the Health Effects of

Mold

The majority of reactions to mold and

moisture in the environment are allergic in

nature and manifest themselves as asthma or

allergic rhinitis. Delayed hypersensitivity is not

uncommon and often less well recognized and

manifests as chronic rhinitis, sinusitis, or

hypersensitivity pneumonitis. Moisture in

buildings has been associated with an irritant

symptom complex: headache, drowsiness,

occasionally cough, dermatitis, and most often

burning and irritation of the eyes, nose, and

throat. The term " sick building syndrome " is

commonly used to describe these irritant

symptoms if they resolve, sometimes

immediately, without long-term consequences,

after the person leaves the environment.

Although toxic syndromes are not well defined

from inhalation exposure of mold or mold

products in indoor environments, many

patients and some physicians have attributed

cognitive and other neurological syndromes to

mold exposures. There is no consensus as to

the nature, pathophysiology, or etiology of

these syndromes. (See chapter 4 and Appendix

B for discussion on health effects of molds.)

Administrative issues arise when the environment of concern is a

place of work (worker's compensation), a school, a rented home,

or a situation insured against loss related to mold or moisture.

Healthcare providers need to provide clear documentation regarding

diagnosis, temporal relationships of symptoms, and findings relative

to exposures and conclusions.

Environmental intervention could be a " fix-it " solution to eliminate

moisture incursion and moldy materials by, for example, repairing

a leaky roof and replacing damaged materials, or it could involve

a program of improved maintenance. (Remediation is discussed in

chapters 6 and 7.) It has been shown that patients with upper

respiratory allergic syndromes, who work in buildings with significant

airborne loads of fungal antigens, can have their symptoms resolve

after the reservoirs of fungal

organisms are eliminated by instituting a more rigorous maintenance

program for the building's heating,

ventilation, and air-conditioning (HVAC) system (Hiipakka and

Buffington 2000).

After remediation, clinical follow-up is critical in evaluating the

success of the intervention. Frequently,

the offending mold can be decreased to a tolerable level, but once an

individual is sensitized,

this may not always be possible. Unfortunately, current methods of

mold detection are not sensitive or

quantitative enough to be able to determine if the exposure has been

sufficiently decreased. The only

assessment for someone very sensitized to mold is to allow the

individual to return to the environment

and monitor his or her condition carefully to determine if there is

an exacerbation of symptoms. Once an

individual has developed asthma, the asthma may not subside

completely, even when exposure to the

original agent has ceased (Chan-Yeung and Lam 1986, Chan-Yeung and

Malo 1995). So, one must

monitor the severity of asthmatic symptoms and the quantity and type

of medications that are required

for asthma control. The severity of the asthma must be carefully

assessed according to the Asthma Task

Force Guidelines (NHLB 1997) and the patient must be treated

accordingly until the symptoms are

stable at the lowest level of severity. At that point, the patient

may be returned, on a trial basis and with

careful oversight to detect exacerbation, to the remediated building.

The medical management of allergic and irritant syndromes is no

different for those related to mold

exposure than for other types. Antihistamines, inhaled nasal

corticosteroids, and inhaled pulmonary

corticosteroids can be prescribed as needed. The clinician needs to

be aware of the possibility that

symptoms are suppressed in the setting of ongoing exposure to

pertinent agents, particularly antigens.

This may result in greater morbidity over the long term because

removal from the environment of

concern may not occur. Concomitant use of medical therapy during

evaluation and remediation of an

environment is, however, not only acceptable but important in the

recovery of the individual.

[Guest guest]

Do you have a link or reference to tte full document, please?

ldelp84227 <ldelp84227@...> wrote:

Below I cut and paste some of the info that doctors are supposed to

do when you report illness accociated with mold. They certainly are

not supposed to ignore this situation. Good info. I have read up to

Page 51. I have more info that is related to symptoms I have on

Serena

There is no such thing as an anomaly. Recheck your original premise.

...Ayn Rand,

paraphrased

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

FareChase - Search multiple travel sites in one click.

[Guest guest]

-Serena, Do you have site.

Here it is posted by Sharon originally.

http://www.oehc.uchc.edu/clinser/MOLD GUIDE.pdf

> Do you have a link or reference to tte full document, please?

>

>

> ldelp84227 <ldelp84227@a...> wrote:

> Below I cut and paste some of the info that doctors are supposed

to

> do when you report illness accociated with mold. They certainly are

> not supposed to ignore this situation. Good info. I have read up

to

> Page 51. I have more info that is related to symptoms I have on

>

>

>

> Serena

>

> There is no such thing as an anomaly. Recheck your original

premise.

> ...A

yn Rand, paraphrased

>

>

>

>

> ---------------------------------

> FareChase - Search multiple travel sites in one click.

>

>