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Bird Fancier's Lung
Bird Fancier's Lung
Allergic Alveolitis (Hypersensitivity Pneumonitis in USA)
Bird fancier's lung is a type of allergic alveolitis ("alveoli" are the air sacs in the lungs and "itis" means inflamed). In America "allergic alveolitis" is usually called "hypersensitivity pneumonitis". It is an inflammation of the parts of the lung were oxygen is taken into the blood. Breathlessness and tiredness are common symptoms, many also lose weight. The main agent that causes the allergy is the bloom on the feathers (the dust that comes off which keeps the feathers sliding nicely over each other). It comes from the preen gland (also known as oil gland or uropygial gland) found under the base of the birds' tail and is spread over the feathers with the beak. The droppings can also be a problem if they dry and are inhaled. Most good quality flying birds keep their feathers in good condition, resulting in lots of bloom. Chickens on the other hand are usually very scruffy and allergy to chickens is uncommon.
Birds visiting your garden are an unlikely cause, most problems occur from birds kept indoors or in breeders. Outdoor birds are generally too far away to be a problem.
This can be a fairly serious disease with breathlessness, fever, weight loss but not usually with wheeze. It gets better when away from birds, and may need other treatment such as steroids. It will recurr when in contact with the birds. A blood test is availble to check for antibodies to avian proteins which is suggestive of disease. There are however more people with antibodies than disease (ie the antibodies can be harmless). There is a lot of cross over between antigens (the things sufferers are allergic to) from different birds and most people think that testing for pigeons and budgerigars is sufficient and will pick out allergy to other birds. The racing pigeons association laboratory in Glasgow, UK provides the reference service. Blood can be sent to Dr C McSharry, Department of immunology, Western Infirmary, Glasgow, G11 6NT.
Further exposure to the bloom (or dust from dried droppings) can make the disease worse. It takes a long time to remove all the bloom from a house or other environment, so if a test is needed to see if the birds are the cause it is better to move the person than the bird (an excuse for a holiday away from home for 4 weeks).
The future is very unclear. There are pigeon breeders who keep their pigeons, reduce their exposures and stay well (
Bourke Thorax 1989;44:415-418
- this paper is very technical). There are a few who get worse even when exposure ceases. If the disease is acute, with weight loss being prominent, substantial recovery should be the norm. You can see if you are still being exposed to the bird antigens by repeated measurements of your IgG antibodies against the bird proteins. They should go down, and usually become negative after about 3 years of avoiding exposure. Dying from acute bird fanciers lung is extremely rare.
Occasionally infection can spread from birds to people. The bird is usually ill (off its seed, green stools, lethargic). The infection is called psitticosis and is uncommon in birds reared in captivity. This causes a pneumonia-like illness rather than any longterm breathing problems. In the UK the infected birds are usually newly imported from the wild, particularly from south america. This should not recurr once you have had it. Psitticosis can be diagnosed from a blood test (Chlamydia psitticae antibodies) which are offered by most standard microbiology labarotories. There are however more people with antibodies than disease (ie the antibodies can be harmless).
Asthma and birds
Asthma can be due to birds, but is uncommon in our experience. If you are worried about asthma due to birds, the best thing is to see if you are better when you are away from the birds. It would be worth keeping occupational type records of your peak flow, before during and after a holiday away from home (you can get information about doing this from this website). It is better for you to move rather than the birds as the allergens from the bird stay in the environment for a long time after the bird has gone.
I have kept chickens for 25 years. I have just started to feel breathless, weak and unwell when I tend to them. Whilst away from them I'm okay. I keep around 60 birds, some in a stable, a shed and others with walk in houses.
Can you please tell me do my symptoms mean anything or do I just perhaps just have a bug.
Regards Pam.
Chickens are an uncommon cause of alveolitis, it would be important to see if you have alveolitis (a chest X-ray, listening to your lungs for crackles, breathing tests including gas transfer, DLCO). If alveolitis is confirmed, then tests for avian antibodies and removal from exposure is best. If you have asthma rather than alveolitis (breathlessness and wheeze, but weak and unwell uncommon), there are many causes related to keeping chicken, particularly if you are breeding them. Red spider mites are one of the commoner causes. Serial peak flow measurements on days at home looking after the chicken, and days completely away from the chicken (details on this website), would be the next step.
Perhaps it is nothing to do with the chicken?
would you like to send us a picture of your indoor chicken to put on the website (a jpg immage would be best)
I have 6 parrots at home and have had parrots since 2004. I have been tested due to a cough and found to have Quote: evidence of Bird fanciers disease. i have added 2 aircleaners and use an approved avian droppings cleaner as well as clorox wipes, and when I remember, gloves with a surgical mask. Though Ive read lots on what causes it, Ive seen little on what to do about it and or, have heard bird store owners say to say good bye to the birds. any suggestions or literature regarding methods of deterring further damage? My lungs are clean per an xray in Jn 09. Would appreciate anything you could offer...Thx. KJ
If one develops bird fanciers lung, it is recommended that exposure to the birds are completely avoided. This does not however guarantee that the disease process will cease entirely in all cases. i.e. in some who develop the condition, the disease may progress or be active in spite of removal of exposure to birds and bird antigens. Ideally, all those who develop bird fanciers lung should be monitored longitudinally in a specialist chest disease clinic and receive treatment where appropriate. X-ray is not a sensitive test by itself in monitoring the disease but forms a part of the available tests used by a chest specialist.
Iwould like some advice. November 1, 2010. We purchased a young blue crowned conure. 1 week later I developed laryngitis, which turned into a cough. I have had this productive cough ever since. I have never smoked and we only have one bird (I had a macaw for 18 yrs, it passed away 4 yrs ago). My chest xray, ctscan and pulmonary function tests are all normal. My parents took the conure for 2 months as a test to see if the bird is the cause (my pulmonary doctor thinks it is, but I tested negative to the skin prick test for budgies and chickens). During the 2 months there was improvement but not long lasting, the cough always came back. I have the bird back now, within 24 hrs of bringing the bird home, I have come down with a fever. The fever is not accompanied with shortness of breath and is only at night, for 2 nights in a row. I have always been very healthy. Could I be having an allergic response to my bird?
Thank you!!! LD
It is possible that you have developed avian aveolitis but the story is not typical, particularly the persisting cough. However the fever on return to the bird is much more in favour of alveolitis than infection (such as psitticosis) which should only have occured on the first contact. The blood test to do is of IgG antibodies to avain serum(or precipitins) for alvelitis and to Clamydia psitticae for psitticosis. The skin prick test identifies IgE antibodies, more related to asthma than alveolitis. If the lung function tests are truely normal (including gas transfer, DLCO) and the CT is normal, alveolitis is unlikely. I think the best way forward is another try at separation from the bird.
I have just been told I may have bird fanciers lung or farmers lung. I have been told to get rid of all my animals. I have chickens, ducks, geese, 2 dogs, a budgie and a rabbit. Do you think it is only the birds - My animals are my life. I can't imagine what I would do without them. I have been keeping chickens for 20 years. Does anyone know if masks work and what sort of masks. I have no cough just pain in my upper back between my shoulders and I feel tight across the chest most of the time. I don't wheeze but My peak flow is never higher than 400. I have children and the doctor says I may be flat on my back with oxygen in 10 years - please advice greatly needed.
Bird fanciers lung and farmers lung are both types of allergic alveolitis (or hypersensitivity pneumonitis as it is known in the USA). Although the disease is the same (alveolar inflammation) the cause is different (avian proteins for bird fanciers lung and fungal antigens for farmers lung). It is important to find out which is the cause for you. The usual method is a blood test for precipitating (IgG) antibodies. Bird fanciers lung is tested against chicken and budgerigar serum, farmers lung mostly against Mycopolyspora faeni, Thermoactinomyces vulgaris and Aspergillus fumigatus. Finding positive antibodies alone is insufficient, as many exposed people have antibodies but no disease. However if you have allergic alveolitis and are exposed to moulds and birds, the one with the positive test is the most likely cause.
Budgerigars are a much commoner cause than chicken, geese and ducks would be very rare causes, dogs and rabbits as far vas I know have not caused alveolitis.
Once you have identified the cause good respiratory protective equipment can help, the pigeon fanciers association (http://www.rpra.org)has good information on this. You can monitor success both by monitoring lung function (particularly DlCO rather than peak flow) and the level of IgG antibodies (they should go down with avoiding exposure)
Can you tell me what tests are available to check for bird fancier's lung. My partner has convinced himself that he has it, but he isn't coughing or wheezing all the time. We have one cockatiel indoors.
Bird fanciers lung causes breathlessness, but not often wheeze. The disease is diagnosed by history (being better when away from the bird for several days), by finding crackling noises when listening to the lung with a stethoscope, and finding reduced breathing tests (particularly gas transfer, DLCO, usually only available in hospital labs). The chest x ray may be abnormal, but is often normal. Blood tests (precipitins) can look for antibodies to avain serum (or droppings). Cockatiel tests are not usually available, but tests for bugerigar or pigeon will usually be sufficient. A positive test is found in exposed people who can have no disease as well as those with bird fanciers lung, the stronger the antibodies the more likely they are to represent disease. The tests become negative after exposure ceases, and there are a few people with bird fanciers lung and current exposure in whom the tests are negative. If you are concerned it is worth doing all these tests.
On Dec 21-2011, I was diagnosed from a CT scan with Emphysema & a 5mm nodule on my left lung after complaining to my doctor of shortness of breath. I also had some coughing and symptoms of a cold that lasted over 3 weeks. He originally did many tests for my heart. Nothing but a premature release of blood that would not cause shortness of breath. I also was diagnosed with systemic lupus the same day, but since the tests keep flucuating that doctor wants me to hold off taking any meds for that and be retested in 6 months. I have owned a Yellow Nape Amazon for 18 years. People have told me my disease was probably caused from the bird. My vet thinks no, but said I should be tested for allergic alveolitis, sampling the birds blood and mine. Since I already have emphysema for which there is no cure, does it matter? I noticed when my bird was removed from my home for 4 days, my shortness of breath ceased and I felt better. I keep his room spotless & also his cage. He gets frequent baths. BUT..I spend alot of time in his room watching tv and such. I am concerned for my health, and do not wish to aggrevate my lungs, but I also love my bird. Do you feel I should have a pulmonary doctor test me for allergic alveolitis & should I give up my pet to save my health? Would this test prove for sure it was the bird or not? HELP!~
As you get better away from your bird you should have tests to find out whether the bird (or something else in your home) is the cause. The simplest test is a blood test for IgG antibodies (precipitins) to the bird's blood (not droppings). Most parakeets cross-react so the test does not have to be to your own birds blood. A positive test does not mean that the bird is definately the cause of the problems, but makes it more likely and further tests are needed. The CT scan usually shown changes of alveolitis when the bird is the cause, the signs can be quite subtle, such as areas of darker and paler lung (mosaic attenuation), or small nodules (many not one) or ground glass opacities, it would be worth somebody having a specific look at your CT for signs of bird fanciers lung. The lung function changes of emphysema and bird fanciers lung can be similar, both can cause low FEV1 and FVC, both a low gas transfer (DLCO) but emphysema should make the lungs bigger (high total lung capacity and high residual volume) and bird fanciers lung lower. If you have both the total lung capacity (and residual volume) will not be as high as expected for pure emphysema. If the diagnosis is still in doubt it may be worth doing a bronchoscopy with lavage of saline into your lung and a count of the cells retrieved, bird fanciers lung causes an increase in lymphocytes (this needs to be done in an area of lung without emphysema, as it is difficult to get the saline back from emphysematous areas).
If you have emphysema it is likely you were (or are) a smoker. Bird fanciers lung is actually more common in non-smokers, if you have recently given up smoking this may precipitate bird fanciers lung which was being supressed by smoking.
The main source of allergen from a bird is the bloom on its feathers, this is often higher on well kept birds and is not removed easily with cage cleaning.
It would be nice if you posted a follow-up in due course to let us know what happened.
I have sever asthma, and lately I have noticed allergy symptoms when in contact with one type of bird, if he bites or scratches me I swell up and it itches incessantly. He is a Quaker parrot, a member of the Budgerigars family. The cockatiels I interact with daily and the Green cheeked Conure DO NOT cause the same reactions. Is it possible I'm only allergic to The Budgerigars? I have an allergy test sched, but that will take MONTHS to get. Removing him from where I live( I volunteer with an animal rescue organization) alleviated all symptoms. My concern are the 3 birds that I live with, whom I love dearly, and other animals I may take in in the future. IS it possible to have allergic reactions only to certain breeds?
I think it is very likely that other parakeets will cross-react with your Quaker Parrot. Immediate reactions from scratches are fairly uncommon with birds (more usual with lab animals). This lype of allergy usually causes urticaria, asthma and rhinitis rather than alveolitis (bird fanciers lung)
I was diagnosed 2 years ago with Bird Fancier Lung. I was given a dove by a friend of mine 9 years ago and after about 2 years with the dove I started having shortness of breath and coughing all day long. I found that it would get worse as soon as I closed the windows up for the winter. I also had a cat and dog so I thought it might be one of them. I finally went to an allergist who tested me for all types of animals and other household things. He came up empty and just called it asthma and eventually had me on 3 asthma drugs which didn't help at all. After coughing for 5 years I finally went to a specialist who tested me for 8 exotic birds and found that I had Bird Fancier Lung from the dove. I got rid of the bird and totally cleaned my house, painted the inside and got new rugs. This helped me immensely up to a point where I still cough about 25 to 35 times a day and never seems to get any better. I cough when I roll over in bed, laugh, do any physical activity or come in from the cold (not when I go out in the cold). In the 6 weeks something has drastically changed. I had a gall bladder attack and was put in the hospital and given large doses of antibiotics for 7 days. When I got out they gave me a prescription for 10 more days of antibiotics. I caught a cold leaving the hospital and coughed severely for 2 weeks. When the cold was over I found that my bird fancier lung cough had all by stopped. I had my gall bladder out after the three weeks and when I came home I still was not coughing. After being home for 2 weeks I have noticed that my coughing is beginning to pick up a little. I have 3 air filters running all the time which I'm sure helps keep the air clean, but my doctor told me I would never be able to clean the house enough to get rid of all the bird dander. My question is that is it possible to cure the bird fancier lung with large doses of antibiotics. It seems that I am real close to being cured by taking the antibiotics and maybe if they kept me on them longer it might have cured me. Is this possible?
Bird fanciers lung is an allergy and not an infection, so will not respond to antibiotics as such. One group of antibiotics (the macrolides) also work to reduce inflammation in a lower dose than needed as an antibiotic; they might account for some benefit in bird fanciers lung.
Your story of you and your bird getting ill together raises the possiblily of the original disease being due to infection and not allergy (ornithosis). This does respond to some antibiotics
Hi all
My health is currently under investigation with doctors and a chest specialist for which I have blood tests for avian precipitins
I have a 6 year old yellow naped amazon and previously had a Jardine for 3 years before that
Since the new year I'm showing all the signs of Bird Fanciers Lung that resulted in a 2 night stay in hospital due to very low oxygen saturation levels (89) and severe shortness of breath
Having read up on BFL and seeing the close connections to pigeons I work in an office where the pigeons roost on the window sill with it 2 foot away from my desk. The window is an old style sash window and not totally secure and you can feel the draught when the wind blows there is plenty of dried Pigeon droppings and dander from them on the window ledge
My question is what would be more likely to set off a case of BFL and would the blood tests be able to determine between pigeons and my amazon at home
I would be totally destroyed if it was my amazon who is cleaned daily without fail I'm leaning towards the pigeons as there is about 10 of them
Any help would be appreciated contact me direct on firstname.lastname@example.com or reply on the forum
Many thanks
The precipitin test (IgG antibodies) in the blood are unlikely to differentiate between the parakeets and pigeons. To get bird fanciers lung your have to breathe in material from the bird to which you have become allergic. Most of this comes from the bloom which coates the feathers and keeps the feathers in good condition, this is to reduced by cleaning the bird cage. It used to be thought that the droppings were the main problem. To breathe these in they have to dry (often a long process). It may be a problem in some places where the droppings are left for a long time. I'm afraid it is more likely that your Amazon is the cause of your problem. It should be fairly easy to remove the pigeons from your office window sill. I would get somebody else to clean this and install netting/spikes or something else to stop roosting. If you are removed from exposure your pricipitin tests (or preferably the titre of your IgG antibodies to pigeon antigens) should halve about every 6 months. If they dont go down it suggests you are still being exposed.
Thanks for your reply I have had the dried droppings on the window sill since the middle of last year Seems odd that I have only just become ill after having my Amazon for 6 years and a cockatiel for 16 years before that We have recently bought a top of the range air purifier for home and that has made a huge difference to the levels of dust/dander in the living room I need to be 100% sure its my parrot and not the pigeons as I spend longer at work than home also the window at work is not totally secure so the dander or droppings could get into the office and I sit 2 feet away from it That's why I was hoping that there was a test that could tell the difference between the 2
Many thanks
i am a macaw owner....16yrs....i have just acquired shortness of breath which causes severe dry coughing. to the point where my bird is saying owww owww! when she hears this . she is pretty cuddly . we spend a a fair amount t of time together when i am not working. i feel good only when i am sleeping which is s 2 sstorey above her cage area. it seems when i go to work though i am worse. and she is n o where near me but it could it be the ledges? what tests are necessary to find the cause?
If you are really beter away from your macaw it makes her a less likely cause of your breathlessness, often longer periods away are needed to show improvement. There are many causes of cough and shortness of breath, you should see your doctor about this. tell your doctor that you have a macaw, he should at least exclude this as a cause of your symptoms by listening for crackles in your lungs (uncommon with many causes of breathelessness), do a chest X ray (can be normal in bird fanciers lung), measure your lung function including gas transfer (DLCO), a low DLCO would be unlikely in other causes of lung disease at your age, and measure your IgG antibodies (precipitins) to bird sera (a positive test makes the bird a more likely cause of your disease). If you are worse at work tell your doctor this as well, the cause may be at work (occupational asthma).
My dad has bird fanciers lung. Is it hereditary?
Broadly speaking,
No. However, if you consider that individuals have different degrees of susceptibility to any environmental dises - those with HLA-DRB1 related genes are more susceptible to bird fanciers lung. Therefore, it is possible that you share the same susceptibility as your forefathers to develop bird fanciers lung, if you have had similar exposure as they have had.
References above.
Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease.
Camarena A, Juárez A, Mejía M, Estrada A, Carrillo G, Falfán R, Zuñiga J, Navarro C, Granados J, Selman M. Am J Respir Crit Care Med. 2001 Jun;163(7):1528-33.
Clearly you need to be exposed to birds first. If you are exposed to birds then the chance of getting alveolitis are higher in some than others, and some of the increased susceptability is inherited. I have added a link to the reference cited by the previous commentator
Camarena A, Juárez A, Mejía M, Estrada A, Carrillo G, Falfán R, Zuñiga J, Navarro C, Granados J, Selman M. ,
Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease.
, Am J Respir Crit Care Med , 2001 ; 163 : 1528-1533 ,
I have had shortness of breath and wheezing for years and I have a starling, the doctor told me it was from smoking I quit smoking and the wheezing went away but Iam still out of breath it does seem to go away when Iam not in the house for long periods of time but I can't move right now. what I would like to know is if it is the bird and I get rid of it how long before the symptoms start going away? and would it help if I put the bird in another room and get an air filter?
Does this affect in pregnancy in any way?
Smoking causes COPD (chronic obstructive lung disease, which includes emphysema) wthis is not caused by allergy to birds. Birds mostly cause allergic alveolitis, and sometimes asthma. All can causes wheeze, but listening (with a stethoscope) might reveal crackles, which are not caused by smoking but are often present in allergic alveolitis. A full set of breathing tests should also help separate the two. Alveolitis and emphysema cause a reduced gas transfer (DLCO), the two can usually be separated by measuring the total lung capacity (up in emphysema and down in allergic alveolitis). Detailed tests are necessarry. Finding antibodies (precipitins) to birds in your blood would also make alveolitis from the bird mor likely. Finally a high resolution CT scan will separate the diseases.
As you are better away from your house it does suggest that there is something there that is making you worse. If it is your Starling it is best to remove it completely. Separate rooms and air filters are not a satisfactory alternative. Particles from the bird may stay in your house for months after removing a bird, but you should notice improvement within a few weeks. It would be best to have regular breathing tests during this time to make sure that improvement is properly documented
My son & I were living in a house that had hundreds of pigeons living in the attic. Their feces covered the entire attic. When we would turn on the heater, thick dust would come out, which we later found out what the dried organic dust of from the feces that was blowing through the air vents. It wasn't until we became ill that we figured out that it was from this. My son had an high IGG level to pigeon feces. Are there any other tests that we can ask our doctors to test us for?
There are many people with exposure to pigeons who have IgG antibodies to pigeon droppings or serum (precipitins) who have no disease. The antibodies show that the individual has been exposed and made an immune response. To find out whether you have alveolitis/pneumonitis you need to find crackles on listening to the lungs with a stethoscope, reduced breathing tests (particularly gas transfer, DLCO, which is usually only available in hospital laboratories) and often an abnormal chest X-ray
Please check on Wikipedia about Bird Fanciers Lung..."certain small mammals kpet as pets have the same or similar protein on their fur and feces and can acerbate the problem in the lungs"...my husband painted on feathers for 15 years...quit 3 years ago...we got a little Yorkie who sat on his lap all the time...he was very, very ill, over and over. Hospitalized many times. We finally figured it out...got rid of the dog...and now he is well. Hope this helps anyone...
Hello, I am a doctor and had to clear the last entry up. You can NOT get bird fanciers disease from dogs, nor Histoplamosis, or any other bird/pigeon related diseases. That is completely false. If you are commenting on here, you shouldn't print things that are untrue. If anything, your husband was probably allergic to the fur on that type of breed, or maybe to all breeds. I suggest getting a dog that has "hair", as opposed to "fur". They are more or less Hypo-Allergenic for allergic people.
RE: the entry from 6/6/12, your son needs to see a pulmonary doctor ASAP. In order to have high IGG to pigeon feces, you must have had very long exposure to pigeon feces, and there must have been an extreme amount of feces. If you or your son are having any breathing problems, or if you are wheezing, feeling flu-like, have fevers, etc, you really need to be treated ASAP. Having exposure to pigeon feces can have a very severe effect on your health. You need to be seen and have a full eval ASAP.
Hello there .. me and my husband have got a ringed parakeet 3 wks ago , within the 1st 2 days my daughter developed a temperature and a cough ,then within the next 4 days 4 out of 8 of our children have the same symptoms, this doesn't seem to be going either .. so I am wondering if this could be a reaction to our new family member .. plz help
Some parakeets have an infection which can be transmitted to humans, causing a flu-like illness sometimes with pneumonia or cerebral symptoms. It is very unusual from birds bred in captivity, but can occur in recently imported birds. This is completely different from bird fanciers lung (allergic alveolitis/hypersensitivity pneumonitis) which are the concerns of most of the questions in this section.Although fever and cough can be due to bird fanciers lung, it would be very unusual for this to affect several people at the same time, and after such a short exposure to the bird. The organism causing infection is called chlamydia psitticae, blood tests can detect this infection which responds to some antiobiotics.
hi i just found out about this disease and currently have a few of the symptoms. i'm trying to make sure i do or dont have it. i'm going to see a pulmonologist next week but i have a few questions. i know coughing is one of the symptons but is it a dry cough or a productive one? mine has been productive. also, does this disease always show on xrays? i've had two and both were 'normal'. i didnt mention that have a bird so maybe they didnt look for the disease in the x-ray? i have one bird, a green cheek conure who i've had for over 4 years. any feedback would be much appreciated. thank you.
The cough is usually but not always dry. The Chest X-ray may be normal with avian alveolitis. The most important tests are listening to your lungs for crackles, and breathing tests to incline DLCO (gas transfer) as simple test of spirometry may be normal. You should also have a test for precipitins to birds in your blood, but some bird fanciers with positive precipitins have no disease.
I have just been diagnosed with pigeon fanciers lung and I am on a course of steroids. I was allergic to our pet budgie which we have since got rid of. I work in the community visiting clients homes which may have pet birds in and also mould on carpets etc. Should I avoid these situations.
This is a difficult question. The allergy to birds is specific, that means that your allergy is only to proteins from birds, particularly from the bloom on the wings and their droppings. Moulds are a different cause of alveolitis, you should have no problems with these. More casual contact with birds in others houses could cause problems and at least temporarily should be avoided. Your antibodies (precipitins) should go down the longer you are away from exposure, if they dont go down (or go up) it is likely that you are continuing to inhale bird protein. Once you are off steroids, and if you are keen, a trial of casual contact could be done. You should have measurements of your breathing and antibodies regularly to see if you are getting problems.
My husband has suffered over four years from shortness of breath, chronic fatigue, severe coughing spasms 24/7, and minor weight loss. He also is cold nearly all of the time. After lung biopsies, MRI's, catscans, and countless blood tests at the top pulmonary hospital and others, he went to the Mayo Clinic in Rochester, Minnesota this week for testing as a last resort.
He called me a short time ago and told me that the diagnosis is Allergic Alveolitis (Hypersensitivity Pneumonitis), as it showed up in blood test results.
We did purchase a parakeet in April but did not see any greater decline in his condition since then but rather the same steady deterioration of his condition. He has had no other exposure to birds other than those that fly by in the sky. We've had the same down comforter for years, live in a fairly new house (6 yrs old and only 1.5 yrs old when his symptoms began), and had the house ductwork cleaned but there was little dust found. There are no other aviary associations.
Is it possible to receive this diagnosis for a possible aviary bi-product? His business is oxygen regeneration devices which include carbons and coconut shells. He travels 50-60% of the time and doesn't feel any better or worse when traveling.
We're pretty sure that we have to give sweet little Lucy away (children's first and only pet) and will get rid of the down comforter, but cannot think of anything else that we can or need to get rid of.
He's been on various steroids and antibiotics for extended periods of time and nothing has worked. Can you help us figure this out? Thank you.
Is he at all immuno-compromised? Does he he take any meds for any health condition that would stop his immune system from working properly? For example, any meds for an auto-immune illness? And is it at all possible that there is any mold in the house? Maybe from an internal leak?
Thank you for responding. No, he is not immuno-compromised. No, he is not currently taking anything but ibuprofin. No, there is no mold in the house and no internal leaks. We are brain-storming as a family right now trying to think outside the box regarding his exposure and can't come up with anything.
The allergic alveolitis seems to have been diagnosed from blood tests. These are likely to be precipitins (IgG antibodies) to a specific allergen, you need to find out which was positive. If the tests are for avian antigens some use avian serum, which does not have serious cross-reactions with other materials, but others use avian droppings which have a lot of things in them other than avian proteins and cross-react with many other microbial agents. A positive IgG antibody test does not mean that the bird is necessarily causing disease, there are many bird fanciers with positive tests and no disease, however in the presence of a disease which is clinically allergic alveolitis a positive IgG test would generally indicate that this was the cause. The cause however should be present before the disease, which seems not to be the case here. Ways forward would include measuring lung function (including DLCO) while living at home and after a break (?holiday, but leaving the bird behind) of at least 2 weeks, the second measurement being made before return home. Improvement would indicate that the cause was at home (the bird being a likely cause). Perhaps the bird needs to go in any case, but further investigation is needed to confirm the diagnosis of allergic alveolitis (rather than its cause).
I forwarded your post to my husband and he is going to share it with his local doctor - the one who referred him to the Mayo Clinic. He's going to ask which type of test was done. I strongly feel that there is an underlying condition causing his symptoms that remains undiagnosed. He is going to request the results of blood work done prior to acquiring a parakeet and have the doctor review them. We have not yet given Lucy away until a comparison of test results has been done. I'm not sure whether he's had the lung function measurement or not but he's taking your response with him so I feel better about him being able to ask more specific questions about the prior testing.
Thank you for sharing your expertise; it is appreciated.
My neighbour has been a labourer and five years ago had to clear out a loft that had been infestated with pigeons. After working on the site he developed breathing problems. He has never smoked and was always really fit. He has been to the Doctors but they have just said that it is as asthma but his wife is convinced that it is not the case. I am trying to do some research on their behalf as would really like to help improve his breathing for him. He sounds very chesty and coughs up a lot of flem all the time.
I have had exposure to seagull Guano both wet and
Dry and atomised by pressure washer! My face neck
And ears came up in a severe allergic reaction and it
Appeared I had been scalded and with flaky skin.
I most definitely ingested by inhalation atomised seagull wet and dry
Seagull faetal matter and I have recently lost 3.5 kg in
Very short time and have a tight chest.what test please
Should I request from a doctor to ascertain if
I have a health problem ?
Asthma is a common cause of breathlessness and has definite tests that can confirm the diagnosis (bronchodilator reversibility, non-specific reactivity, increased diurnal variation in peak flow, response to a trial of treatment etc.) None are found in all asthmatics, but most have at least one of these.
If thge reaction occurred on your first exposure to seagul guano it is more likely to be irritant than allergic, both can cause skin problems. Weight loss is more unusual but could be due to organic dust toxic syndrome, if so it should improve fairly quickly. If weight loss continues it is important to seek medical advice.
Thank you for your speedy response regarding the gull guano.i have had some tests done and my blood pathology states pidgeon droppings igG [26-50]was 67.7 and chicken droppings igG [10-40] were 41. both chicken and pidgeon feather counts igG were also on top of range.I am led to believe that pidgeons are used as a base for all non aviary birds is that correct assumption?i am having a chest x ray and further blood samples and am short of breath would this be indicative of contamination of guano in my body?
Pigeon droppings are often used as a surrogate for different avian species, there is a lot of cross reactivity betwwen birds. Dropping are not ideal as they contain many things apart from the avain protens which are the cause of disease, particularly bacteria which occur in contaminated water aerosols (fountains etc). The better tests use pigeon seum (pigeons are easier to bleed than smaller birds)
Our small parrot, a family pet, needs a new home according to our pulmonary Dr. My husband has COPD w/asthma, allergy test to birds negative. He was not allergic to hardly a thing. I am wondering what we can do to be sure that finding our loved pet a home is the right thing. He wants to be assured that this is right. He is not responding to steroids, antibiotics, inhalers, etc. He has a rattle in one lung and has a bronchoscope scheduled. Dr. feels that he may have a blockage. symtoms are worsened with any activity; he has no life in a recliner day after day. He is 72yrs old has been very active until these lung problems. What do you think? Is there anything we have missed. I feel I have lost my partner.
The most important thing is to make a correct diagnosis. If you have asthma or alveolitis shown to be caused by the bird, the bird should go. If not there is little point in removing the bird. If the diagnosis is equivocal a trial separation is a way forward, the patient rather than the bird should go for about 4 weeks, with no return home at all and careful monitoring. Antigens from the bird may still be in the house many months after the bird goes which is why the patient rather than the bird needs relocation.
Kept finches in a birdroom with use of an outside aviary
The last few times I cleaned the birdroom I've had a cough non productive,
And breathlessness with wheezing which all symtums clear after
About 3-4 hrs.
Because of this complaint I finished bird keeping which really
Annoyed me, maybe I should have tried a few preventatives.
After a few months away from birds my then complaint got better
So I thought about picking the hobby back up.
Never had any symptoms in the first 4 years of keeping finches but the last
2 months was not nice.
Should I restart my hobby with mask wearing and also
Run a hepa air purifier.
Love birds but want to be safe in doing so.
Your symptoms sound more like asthma than alveolitis, but both may be possible. They are due to allergy so require a period of exposure before sensitisation occurs (just like hay fever to grass, you are not born with this but starts usually years later despite breathing in the grass pollen every year). Once developed small exposures which caused no problems before rovoke symptoms. Now that you have got rid of the birds it would be much safer to stay away from exposure.
Thanks for your reply.
Currently got one pair of finches(Siskins) to try.
Purchased an expensive air purifier which has a 6 stage
Purifying process inc hepa.
I also wear a mask(ffp3) type and use prevalin nasal spray.
When I enter my birdroom I also wear a Lab type
coat which I leave in the"clean area"of my birdroom
As you can see I have taken/made all precaution
And expense available to me.
At the moment all seems ok, as long as I keep to
this system then maybe I can continue my hobby.
The moment the symptoms return I will rehouse
the birds and move on.
Do you think this wise, love the birds but I also
want to keep myself safe.
Kind regards
Ps... Should I book an appointment with my GP
for investigation.
I moved into my present home in July 2011, since February 2011 I have been suffering symptoms. My question is: Is it possible to be affected by living near someone who breeds birds and has an Aviary? The person living next door to me has an Aviary which adjoins on of his bedrooms at the back of his house, and which is outside my bedroom window?
It seems that your symptoms started before moving next to the avairy. The aviary is a very unlikely cause of your symptoms
hello i have been sick since mid jan this year, i now have chronic asthma and a lot of tiredness, coughing all night and morning, i am taking note of peak flow my highest reading is 310 i am 31 non smoker, i have also from coughing have fractured 3ribs am in alot of pain alot of the time. i have been in hospital 4times and doctors with same and also worse symptoms and everyone is baffeled as am i. any ideas????
hi this is sick since mid jan, , i just got rid of two of my birds leaving me with one.
Is it unhealthy to have my finches housed (caged) in the bedroom?
You are very unlikely to get infection from them, but it increases your chances of getting asthma or alveolitis (pneumonitis)
I was diagnosed with PBL in 2007. I have had pigeons since 2005, but quit smoking June 2006 and sick within months. Started smoking again and stayed with my pigeons until 2012, when I started coughing incessantly at night, then became hypoxic. Cat scan showed return of the disease. I still have my birds, but stay out of the loft and where a mask when I'm near....giving baths, changing waters, etc. Last Cat scan showed marked improvement and I no longer have to use the oxygen except while exercising (4 liters) and connected to CPAP (2 liters) You're going to think I'm off the wall, but I would like to use my pigeon droppings as fertilizer. At what point would this be safe to do? The proteins must dissipate eventually? Thanks for your help.
The lung disease is due to inhaling antigens (things you are allergic to) from the pigeon, the droppings being one of the main sources. If you require oxygen to breathe I would have thought that the time for complete removal from exposure to pigeon antigens is long past. There are safer sources of fertilizer
I understand that. I would assume, after time, the antigens dissipate. I do not require oxygen to breath, except when exercising (treadmill, bike) when the ox sat may drop. I have improved greatly since I am staying away from the loft. I still release my birds at funerals and weddings, but do not enter the loft at all. Even just outside of it, I'm wearing a respirator. I do not have COPD and even my pulmonary function tests have improved greatly. Are there really safer sources of fertilizer? Again, I would think that the allergans would go away after a time. I am finding a way to compensate. I am 66 years old and getting rid of my beautiful white birds and not being able to help reduce the sadness of a loss of a loved young, I believe would cause undue stress and not improve my life
You can tell how effective your precautions are by measuring the titre of your IgG antibodies (precipitins) to pigeon antigens serially, say every 6 months. Without exposure they should halve every 6-9 months. If they dont go down it suggests that you are inhaling antigen from somewhere. The test needs to be done quantatively, for instance with an ELISA, and not by looking at precipin lines on an agar plate.
I am diagnosed with HP or AA and the cause according to the Pulmonologist: bird fanciers disease. I do not own any birds. My neighbour (30 meters away)has got about 15 parrots in cages outside. I've got a water fountain which means that pigeons (about 40+) regulary come to drink. They also sleep in the trees which surrounds the house, their droppings all over the paving. But that is all outside. Question: Seeing that the pigeons and parrots are all a distance from where I live, is it still possible to contract this disease?
Thank you
"According to the Pulomonologist", meaning that all necessary titer tests were performed? I have my 50 or so pure white pigeons in a loft in my backyard. I have a Blue and Gold Macaw in my house. I was tested both for parrot and for pigeons. I am able to keep my parrot, but must stay out of the loft. I can still take my birds for a release. Their baskets are not in the truck, but in the bed. I hold them and give them to the client for hand release. I am not allergic to the bird. I am allergic to the antigens that their poop produces. Inside the loft, they fly around and all this little dust like particles are flying. I find it hard to believe that a proper diagnosis was made. Ask for a copy of the blood work.
PS...To whoever answered my last post. I have printed it and will take it to my pulmonologist. Originally, when I was first diagnosed the reason was poo poo'd. The US knew nothing about the tests that were done in the UK. Doc said "What difference does it make? We would treat you the same." I've had to push for everything. Most is available in the states now and I will insist on having the IgG done
I'm the person with the HP / AA written on 25/07/2013. Yes, the specialists performed an open lung biopsy. The pathologists diagnosed the condition as allergic alveolites (AA). The only contributing factors to the illness is that which I mentioned in my Comment. Hence my answer.
God bless
Having HP, even with a definite biopsy, and having birds nearby, does not necessarily mean that one is the cause of the other. IgG antibodies help, if these are negative during current exposure it makes that cause much less likely. If the antibodies are positive it means that there is some exposure, but not necessarily that the cause is found. A challenge test is ultimate proof. Another option is to measure lung function, including gas transfer, then leave the home without return for 2-4 weeks, then repeat the lung function before returning home. If there is no definite improvement with complete removal from exposure it makes a domestic cause much less likely. If improvement occurs it could still be something in the home apart from the birds, moulds being the most common.
An open lung biopsy will show all the characteristics of AA /HP Blood tests: inflammatory markers may be raised but are nonspecific. There may be serum antibodies detectable in some patients but there are no detectable antibodies in many. The presence of antibodies is nonspecific, as they may also occur in those who have been exposed but have no disease.[1][3] Despite the pitfalls of false positives and false negatives, analysis of antigen-specific IgG antibodies can be useful as supportive evidence for diagnosis.[6] The antibody titre level may also be helpful.[12]
I have had 3 chickens in my backyard for the past 1 1/2. I moved them out of the dirt to another area with tanbark and way less dirt. BUt then I raked up their feces and lots of dust was flying everywhere. I wore a bandana over my face to protect myself but now I am concerned about getting sick? Will I come down with this lung illness? Should I move the chickens further away from our house? I have not shown any real symptoms so I think I am fine but I don't want my kids getting sick from inhaling dust on a windy day? Should I take any precautions with these birds?
The percentage of people that get BFL is very low. Nobody should be inhaling dust from anything. Don't do it on a windy day or wear an N95 respirator....they don't have them for children, that I know of.
Allergic alveolitis from chicken is very uncommon. The main source of allergen (the material that causes the allergy) is the bloom on the flight feathers of birds, which comes from the preen gland, and is spread over the feathers by the bird preening. This is needed for good flight feathers. Chicken are usually scruffy birds and do very little flying and dont spend much time preening, and have low levels of bloom, and consequently are a low risk for causing alveolitis, even in those very heavily exposed in indoor breeding sheds. Asthma can then be a problem, and is sometimes due to red spider mites which can infest the young birds and their nests
I am in disagreement with the above comment. Pigeon Breeders' lung is caused by pigeon droppings. Not by the bloom on the flight feathers. I can handle my birds, outside of the loft. I'm not "allergic" to my birds. It's their poop that was causing the inflammation of the alveoli. Their flying around the loft and the antigens from the dried poop flying all over the place, makes it impossible for me to enter the loft. Even with a respirator.
Allergic alveolitis from chicken exposure remains very uncommon, despite the poop
My husband has been diagnosed as having allergic alveolitis. We have had a budgie for 10 years and my husband showed no signs of this allergy until this year.If my husband is allergic to budgies, should this not have happened when we first got a budgie ?
Alveolitis is caused by allergy. This takes time to develop, there is always a gap between first exposure and disease. Problems following first exposure mean that the exposure is toxic or irritant and affects most exposed people. Bird fanciers lung only affects a fairly small proportion of those exposed, as it is due to allergy.
A gap of 10 years before disease occurs seems quite excessive. My husband is immuno - suppressed following a liver transplant 12 years ago and also has sarcoidosis of the lungs. Can either of these two problems have triggered this allergy ?
My mother was diagnosed with IPF 10 years ago after going to the doctor for chronic cough and breathlessness. She stopped going to the doctor after a year and has refused to go back until now. Since she is still alive, it is obvious she didn't ahve IPF. However, her lung function has decreased from 78% to 65%.
She was given a ringneck parakeet a few years before her initial diagnosis.
When she went to a different pulmonologist last week, he told her she had a positive ANA ten years ago and that she likely has an autoimmune connective tissue disease. He did extensive testing for autoimmune disease and antibodies. This time her ANA was negative.
But she had antibodies to mixed feathers, pigeon droppings and different molds. Her antibodies to the pigeon droppings was triple the high end of the reference range(36) and antibodies to feathers was double(11). The doctor said most people are positive and if the bird were the problem, her antibody numbers would be much higher. Is this true? She also uses down bedding in the winter. Could that be the culprit and the reason for her lower numbers in the warmer season? She is fighting getting rid of the bird.
thanks in advance for your replies.
Regular contact with birds can cause pulmonary fibrosis of any kind, including a disease indistiguishable from Idiopathic Pulmonary Fibrosis (IPF). The bird exposure obviously has to come first, as it seems in this case. The precipitating antibodies (IgG antibodies) denote exposure more than disease, the disease can be present when the antibodies are negative, which often happens some years after the bird exposure ceaases. Positive Anti Nuclear Antibodies (ANA) are common in any type of pulmonary fibrosis, only if the titres are very high (say >1:1600) is a connective tissue disease the more likely cause of the pulmonary fibrosis. It is a brave doctor who thinks the bird is an unlikely cause for the pulmonary fibrosis. There are things that could make the diagnosis clearer. A bronchoscopy and high volume lavage with differential cell count of the fluid should show an increase in lymphocytes if the bird is the cause. It may be possible to take biopsies at the time which can sometimes clinch the diagnosis of allergic alveolitis (hypersensitivity npneumonitis). The CT scan can also suggest this diagnosis. Finally a trial away from the bird for at least 4 weeks might help with the diagnosis (it is your mother rather than the bird that needs to move, as the antigens from the bird are still present many months after the bird goes).
Thank you for answering so quickly. I am trying to get my mother in for another appt., so I can ask questions, but the pulmonologist wants to see her at the same time as a certain rheumatologist and the earliest she can be seen is two months from now.
Coincidentally, I just received the report from the CT scan she had two weeks ago. Below is the report.
PROCEDURE REASON: Postinflammatory pulmonary fibrosis
* * * Physician Interpretation * * *
CT CHEST WITHOUT INTRAVENOUS CONTRAST: High Resolution
History: Postinflammatory pulmonary fibrosis
Technique: spiral CT was performed through the chest with reconstruction
of contiguous 3 mm axial images. No intravenous contrast was utilized.
Dose-Length Product (DLP): 147 mGy*cm.
CT Dose Reduction Employed: Yes
Findings: Comparison exam is from 07/25/03
PULMONARY PARENCHYMA: The lung bases are nearly completely replaced by
thin-walled short axis diameter predominantly around 5-12 mm.
Particularly on coronal reformations many of these lucencies appear
cylindrical. Pattern consistent with cylindrical bronchiectasis and
honeycombing. The pattern extends into the medial superior lingula and
medial right middle lobe. Localized mild bronchiectasis lateral right
midlung and left upper lobe anterior segment and lateral left upper lobe
near the level of the aortic arch. Posterior right lower lobe airspace
disease consistent with mild peripheral bronchiectasis and subpleural
honeycombing. There are scattered other areas of subpleural airspace
disease which may represent minimal fibrosis or peripheral
bronchiectasis. Bilateral minimal peripheral honeycombing
MEDIASTINUM AND HILA: Small pericardial effusion. Retrocaval-precarinal
node 1.6 cm in diameter. Retrocaval-pretracheal nodes with largest 1.6 x
1.7 cm in diameter. Anterior mediastinal 1.0 x 0.7 cm There are a few
nonenlarged superior mediastinal lymph nodes.
CHEST WALL AND PLEURA: No pleural effusion
UPPER ABDOMEN: Limited views are unremarkable
Interval progression of bronchiectasis and pulmonary fibrosis
Mild mediastinal adenopathy. These lymph nodes are increased in size
from previous study. Some of the non-enlarged lymph nodes are new from
the prior study.
Pericardial effusion is new from previous study.
Thanks again for your quick, knowledgeable and very helpful reply.
Thank you for answering so quickly. I am trying to get my mother in for another appt., so I can ask questions, but the pulmonologist wants to see her at the same time as a certain rheumatologist and the earliest she can be seen is two months from now.
Coincidentally, I just received the report from the CT scan she had two weeks ago. Below is the report.
PROCEDURE REASON: Postinflammatory pulmonary fibrosis
* * * Physician Interpretation * * *
CT CHEST WITHOUT INTRAVENOUS CONTRAST: High Resolution
History: Postinflammatory pulmonary fibrosis
Technique: spiral CT was performed through the chest with reconstruction
of contiguous 3 mm axial images. No intravenous contrast was utilized.
Dose-Length Product (DLP): 147 mGy*cm.
CT Dose Reduction Employed: Yes
Findings: Comparison exam is from 07/25/03
PULMONARY PARENCHYMA: The lung bases are nearly completely replaced by
thin-walled short axis diameter predominantly around 5-12 mm.
Particularly on coronal reformations many of these lucencies appear
cylindrical. Pattern consistent with cylindrical bronchiectasis and
honeycombing. The pattern extends into the medial superior lingula and
medial right middle lobe. Localized mild bronchiectasis lateral right
midlung and left upper lobe anterior segment and lateral left upper lobe
near the level of the aortic arch. Posterior right lower lobe airspace
disease consistent with mild peripheral bronchiectasis and subpleural
honeycombing. There are scattered other areas of subpleural airspace
disease which may represent minimal fibrosis or peripheral
bronchiectasis. Bilateral minimal peripheral honeycombing
MEDIASTINUM AND HILA: Small pericardial effusion. Retrocaval-precarinal
node 1.6 cm in diameter. Retrocaval-pretracheal nodes with largest 1.6 x
1.7 cm in diameter. Anterior mediastinal 1.0 x 0.7 cm There are a few
nonenlarged superior mediastinal lymph nodes.
CHEST WALL AND PLEURA: No pleural effusion
UPPER ABDOMEN: Limited views are unremarkable
Interval progression of bronchiectasis and pulmonary fibrosis
Mild mediastinal adenopathy. These lymph nodes are increased in size
from previous study. Some of the non-enlarged lymph nodes are new from
the prior study.
Pericardial effusion is new from previous study.
Thanks again for your quick, knowledgeable and very helpful reply.
I was diagnosed with Bird Fancier's lung in early 2013. I had chills, heavy coughing and my x-rays had the ground glass effect. I'd been given a couple of rounds with steriods, which had helped, prior to seeing the pulmonologist. He put me on a longer round and my lungs did clear up. We have three macaws in the house, two cockatoos in the garage. I've not had any direct contact with the birds since I got sick.
I have three large hepa filter air filters, which do help. I am still in the process of trying to move the birds out of the house, but the articles here make me think I might do better to relocate to the shed for the day. I seem to be okay as long as I do not have the house closed up. I will be going in for another check up later this year.
It would seem that the macaws would be better in the shed than you. Continuing exposure to indoor birds is always a risk, it is very difficult to limit your exposure sufficiciently while the birds are indoors, and even quite difficult when they are ouutdoors. If steroids are needed for you I think you come before the birds.
Hi. I have a Green Cheeked Conure who seems to be causing some breathing problems. My symptoms are tightness in the chest with slight wheezing and a thick clear sputum. My chest also feels irritated. I am asthmatic and take preventative medication. I also have allergies to grasses, dust mite and quite a few animals including cats and horses. My allergy specialist did an IgE test for parrot feather but it came back negative. I have had the test twice. The first was 8 months ago and the second just recently. I am still not sure it is the bird however I do seem better away from him. Could it be his seed? The bird is kept inside and I have quite a lot of direct contact with him. I have had him for 10 months. I really don't wont to part with him but I will if I can't find a solution.
Hypersensitivy pneumonitis (EAA) is much more likely to be due to the bird than asthma. IgE may be negative, the test should be with avian IgE (precipitins). The disease affects the alveoli and is best diagnoses with measurements of gas transfer (DLCO) Seed allergy causing asthma is also a possibility. If you are better away from the bird, this seems a good way forward.
I have just bought a budgie for my son. His father has cystic fibrosis and is concerned that his health may be compromised by me having the bird at my house. Can my son carry allergens on his person that, when he goes to his father's house, may cause him to develop bird fancier's disease and further damage his very sensitive lungs?
Any risk would be very small, unless the contact is already allergic to birds. It is possible to carry antigen on clothes after close contact with birds, but would be much more common with large birds such as pigeons which are regular handled and inspected. As far as I am aware there are no reports of sensitisation to birds from material carried on others clothes, although this has been reported for some very potent sensitisers such as platinum salts. If you are worried in might be sensible for your son to put on clean clothes before visiting his father
Venables KM, Newman Taylor AJ ,
Asthma related to occupation of spouse
, Practitioner , 1989 ; 233 : 809-810,
Your thoughts on the saturated fat concept in extrinsic allergic alveolitis? Have read about it in Racing Pigeon Digest.
Please send a copy of the article or a reference so that we can make a comment
Sorry, but neither take me to the breeders-lung website, cant get beyond the homestead home page
I have now found the article by typing breeders-lung into google, the address seems the same, one link works, one doesnt
It is true that the air-sacs in the lung are covered with surfactant which is a fat and is needed for the lung to work. Surfactant however is made in the lungs, and does not come directly from the diet. There are many theories about cures for disease; there are established ways of finding out whether they work, doent work and cause no problems, or are harmfull. This requires a randomised controlled trial. Without this it is not possible to diferentiate between association (when one thing follows another but are unrelated) and cause (when one thing causes the other)
had a double lung transplant in 2011.For three years I had a very high PFT on regular basis. Am currently in rejection and my pft's are 1/2 of what they were in
in 2011 I had a bilateral lung transplant.For 3 years my pft'ss were in the 4.5range.today pft's are 2.70 to 3.05.in feb 2014 pft was 4.58. could having a canary have affect on this sudden drop? I am in rejection and rate 2a on scale used to determine rejection level. Is it the feathers or whats on the feathers?
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The Packaging
Scythe uses an all white background to display the purple and grey wolf on the left, and it makes for a nice contrasting backing for the case image at the bottom right. At the bottom left corner is the first indication of the 'designed in Germany, by "benny"' concept.
Scythe uses this panel to display useful website information for contact and support. In the bottom left corner, again is a Benjamin Franz logo.
We get our first look inside the FenrisWolf as Scythe shows the major features within. The specifications are listed in six languages at the bottom.
One the last side panel, the wolf's neck and ear are visible as the image from the front wraps around. Here we see both the rear and the front with the door open.
Scythe caps both ends of the chassis in Styrofoam and lines the case with a thick plastic inner liner that is taped, very securely, closed.

subset: commoncrawl


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Hello everyone! I am doing an art collage project and would love a poem to go on it. My husband and I are devoted fans of the orchestra Trans-Siberian Orchestra. We are part of the fan club and everything. So, I just received fan club baseball hats and my 2 year old daughter Skylar won't leave the hat alone. I have taken 4 pictures of her wearing the hat and she is just too cute!! I am planning on making a collage of these pictures and presenting it to the leader of the orchestra when we see them on Dec. 27th. If any one of you wonderful poets would like a challenge to come up with a poem I would be most thankful!!
Here are some ideas... Skylar is the littlest fan, TSO is the nickname for the orchestra and Chris Caffery is the leader of the orchestra and it is his fan club that we are members of. I know it is a challenge but I thought maybe you all could help me out. Thanks in advance! Jenn |
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Go to http://www.twopeasinabucket.com/words.asp click on "View by Categories" There are a lot of poems there. That's where I have found a lot of poems I use in my PC Scrapbooks. Hope this helps |
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I did get to listen to both growing up and as an adult. But I really did like Irons version a lot better, don't know why though.
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I did get to listen to both growing up and as an adult. But I really did like Irons version a lot better, don't know why though.
You know, after 43 trips and many many rides on Spaceship Earth, I don't favor anyone but am just glad the attraction is still there, never really paid attention to the narrator. It's one of the most informative and relaxing attractions in EPCOT so I didn't vote.
i wonder if anyone even remembers the Larry Dobkin version... i know i wasnt around for that one...
Having experienced all but Judi Dench whom I will see in short order, I would choose a hybrid. While the Cronkite version of the ride with the Tommorow's Child ending is my favorite version of the ride, I find the music and narration in Jeremy Irons' offering the best. He has such an ethereal quality in this attraction. I love hearing "like a grand and miraculous starship.." etc etc
I like the Irons version because that's what I'm used to. I love his voice. Dench is okay and her voice is okay for the ride but I'm just sooooooo bored after the "earth in space" scene. I know they've got the video thing going on but I really miss the scenes that happened on the descent. I'm sure that has something to do with my preference for the Irons version.
(Insert comment here).
Great point!
I think the descent was better in the Jeremy Irons version because we can all relate something back to ourselves watching the people in those scenes. I was more invested with that version of the descent.
It is fun in the current version though to know what I would look like with a cartoon body. :grin:
if inly we could go back in time... and change Disney's mind about this attraction...
It just seems wrong to vote against Walter Cronkite about anything to do with his narration or voice...
BUT, I voted Jeremy Irons. The ride scenes, the script, the soundtrack, the voice, "the Renaissance..."
Jeremy Irons version had the best narrator with depth, best script, best score and best descent. But I'd happily try the Lou Mongello version.
Jeremy Irons, by far, was my favorite. It's the version I have the best memories of, and I feel when it started (1994), EPCOT was at its peak, so that just all kind of adds in. Great writing and presentation also.
From what I've watched online (I never saw the Cronkite version), the Judi Dench narration looks the least impressive.
I do have a lot of fun trying to make different videos each time, as well as making as ridiculous of a face as I can for the videos... but nothing beats the music and images from the Irons version.
That and his voice just lends a strange sort of sage wisdom to the whole thing, the way he delivered his lines made it seem like he'd been there for each of the big events he mentioned, like a sort of Father Time or Father of Communication... or maybe that's just the way I listened to the reading.
Judi Dench does a fairly good job with the material provided, but her tone is much more light, and the script is a bit less majestic as well. Ah, well, at least I still have the Irons version to listen to on YouTube. :thumbs:
I'd have a hard time choosing between Cronkite and Irons. They were both excellent narrations.
Densch isn't really that bad, I just think the sour taste the descent leaves in my mouth subconsciously makes me grade her much lower.
OK, so I finally decided to go with Cronkite.
I also thoroughly love his narration that they use for Illuminations during the holidays.


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UpYours Concert
Taken by fuckdaniels with a Lomography Fisheye No. 2 loaded with 200 ISO Kodak Farbwelt expired 2006 12 exp film in Bamberg, Germany. These tags describe this photo: bamberg, upyours, fuckdaniels, double, aweseome, hair, face, peple, alcohol, dope, smoke, crust, punk, hardcore, music, hectore-savage, and concert. Date: 2013-02-23. Time: Dusk. This photo can also be found in the album LSD is eh ok..Please login to get more out of this site
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Assistant Secretary for Health Howard Koh Shares Hepatitis B Awareness Tools for AAPI Communities
As we approach World Hepatitis Day on July 28th, we are reminded of the staggering impact of Hepatitis B in Asian American and Pacific Islander (AAPI) communities. AAPIs make up approximately 5% of the US population, but comprise over 50% of Americans with chronic Hepatitis B. This means approximately 1 in 12 AAPIs are living with chronic Hepatitis B.
Last month, Assistant Secretary for Health Howard Koh, MD, MPH shared a "Dear Colleague" letter with the AAPI community highlighting many valuable new information resources and tools about viral Hepatitis tailored specifically for AAPI populations. Since working to reduce the disproportionate impact of Hepatitis B in AAPI communities is an important priority of the White House Initiative on AAPIs and the Department of Health and Human Services, we wanted to share Dr. Koh's letter with you and invite you to consider making use of some of these valuable resources yourself and in your work in your community.
In his message, Dr. Koh notes that, "as a result of the unprecedented coordination and collaboration among federal partners brought about by the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, we [now] have access to a number of new tools to support our ongoing awareness efforts."
Encourage your loved ones and community members to take an online Hepatitis risk assessment; increase awareness about Hepatitis Testing Day utilizing new posters available in English, Chinese, Korean, and Vietnamese; share a video public service announcement to encourage AAPIs to talk to their doctor about getting tested for Hepatitis; and access many more Hepatitis education materials for patients and health care providers.
Broader dissemination and use of these tools, especially by organizations working with AAPI communities at risk, will have a positive impact on our efforts to reduce viral Hepatitis disparities in the AAPI population. As Dr. Koh notes, "Working together, we can make great strides in addressing this epidemic."
Kate Moraras, M.P.H., serves as Senior Advisor in the White House Initiative on Asian Americans and Pacific Islanders and Corinna Dan, R.N., M.P.H., serves as Viral Hepatitis Policy Advisor in the Office of HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services.
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A Merry Christmas with the Lich King
Brilliant. The costume is great (even if the idea of Arthas as St. Nick is a little silly), and the pictures, by Brooks Reynolds, are very well done. One question, though: where's the candy cane Frostmourne?
Filed under: Analysis / Opinion, Fan stuff, Virtual selves, Humor, Lore, NPCs


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Wed, Oct 17, 12 at 18:41
You can read the article for the full story. A guy posted a comment to a facebook page for a maxipad company about how their commercials misled him about *that time of the month*. The company made a humorous video response to the comment.
I don't find the video offensive, but posted the warning for the sake of those who like to be easily offended. |
Here is a link that might be useful: Bodyform ad
Follow-Up Postings:
LOL! I LOVE her accent. |
that was a HOOT! Thanks for posting! |
Loved it! Thanks. |
See, because we live in the US, we miss out on some fabulous commercials. This was done in the UK, where humor is a bit more raunchy. I thought it was funny....anyone else catch the toot at the end? :) Classic! |
Saw this in FB. So funny. |
The toot was too funny, oh, sorry Richard, you did know that we do that too right? haha Crimson landslide, hilarious!! |
very funny indeed !!!! |
That was great--thanks!! |
Very funny! lol |
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Bought this mammillaria "fred" monstrous over the summer and when I repotted the plant I noticed that it was grafted. I don't know much about grafted plants, but I felt somewhat cheated. So here are some questions regarding grafted plants: 1. Can a grafted plant stay on the root stock indefinitely or should it be separated at some point? And if so, when? 2. In a c&s show are grafted plants frowned up? 3. If a plant was once grafted but later separated from root stock does that have to be disclosed in a c&s show? 4. Is grafting something I should get into if I want to grow prize winning plants? It intimidates me a little, but sounds interesting. Your help is greatly appreciated, |
Follow-Up Postings:
- Posted by cactusmcharris 4 / Interior BC (My Page) on Wed, Dec 5, 12 at 23:03
Q&A time, eh? Well, since I respond well to monstrous growth, I'm here for you 1) IMO&E, it should be - 'Fred' can be grown on its own quite easily, once it's (the scion) outgrown the stock. 2) Usually covered up by strategic potting / top dressing in a / for a Show. 3) Thank you for a question about the details - I would say it depends on what it's growing as at the time of entry - a grafted plant or not. 4) Grafting does put a jump start on slow and slow-and-difficult plants, to get them to maturity / flowering (and seeding) size, there's no doubt. Additionally, most new species (I can think of Digitostigma as a recent example) are grown on grafted stock to get them to maturity / flowering size / pupping/cutting size more quickly, and it works for that reason. For others, it's aesthetics aiding / preventing them. |
This post was edited by cactusmcharris on Wed, Dec 5, 12 at 23:06
Thanks so much! If I wanted to start experimenting with grafting succulents, where would you recommend me starting? What plant is easy and meaningful to try? Aztekium ritteri is on my wishlist, but probably not a good plant to start with :) |
(I think I unsubscribed from this thread, not sure how to activate it again without sending a message.) |
- Posted by stephanie_kay 5a IL (My Page) on Thu, Dec 6, 12 at 7:11
Just put a check back in the box right above the 'Preview Message' button. Stevi |
But you have to submit a message for that to take effect, no? |
- Posted by stephanie_kay 5a IL (My Page) on Thu, Dec 6, 12 at 11:58
I think so |
- Posted by wantonamara 8bTx (My Page) on Thu, Dec 6, 12 at 18:44
I ususally backtrack and then resubscribe if I catch it and haven't clicked off yet. |
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4th of July Charity Auction
The Sign of the Orz organizes this multi-beneficiary event that includes live and silent auctions, raffles and other activities in Bellevue, Wash.
Volunteer Your Time
We celebrate the passionate individuals who have organized fundraising events for Fred Hutch over the years. All levels of events are appreciated – from golf tournaments and dance performances, to bake sales and fun runs. All funds raised make an impact in accelerating lifesaving breakthrough research.
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See more events in our In the News section.
The Sign of the Orz organizes this multi-beneficiary event that includes live and silent auctions, raffles and other activities in Bellevue, Wash.
This event is hosted by Delta Tau Delta Fraternity at the University of Washington. Contestants from multiple sororities vie for the title of Miss Greek by competing in several categories, including: fundraising, talent, philanthropic services and community awareness, and personality.
Organized by the North Mason Cancer Crusaders, Jail and Bail is an annual autumn event where local community members in Belfair, Wash., sit in a makeshift jail cell and raise money from passersbys to get out of "jail."
Organized by Mo-Dazz for the Arts and inspired by a cancer survivor's story of hope, this annual event features a silent auction and dance performances.
Each August, the Klingmans and friends host the Klingman Open, a golf tournament that raises funds for the Family Assistance Fund, which provides financial assistance for housing, groceries and transportation to patients and families in need.
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Amish Mafia star Lebanon Levi
Sunday, March 24, 2013 5:08 PM
Kori Heffner, 15, of Schuylkill Haven, Schuylkill County, has her shirt autographed by Amish Mafia star Lebanon Levi during an appearance at the Matthews Public Library in Fredericksburg. Paul Chaplin | email@example.com
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- 'Amish Mafia' star Lebanon Levi welcomed by cheers at Lebanon library meet-and-greet March 24, 2013, 6:15 PM
- 'There is no Amish mafia' says Amish expert March 26, 2013, 7:18 PM
- Who is your favorite reality TV star from central Pennsylvania? April 18, 2013, 9:00 AM
- 'Amish Mafia' Update: Criminal actors, Lebanon Levi appearances and the end of the 'Amish Mafia Tour.' May 15, 2013, 11:47 AM
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Big Changes at Target: Go International Goes Bye Bye
Before designer collaborations became an everyday occurrence, Target launched Go International as a way to introduce high-end fashion to a larger audience. Now, the line responsible for bringing Proenza Schouler, Richard Chai and Thakoon to the masses has been discontinued for a new model.
WWD reported today that exact details are still tightly guarded, but the 2012 system will "encompass a variety of different departments across the store, from food to clothing to home to pet food." We can only imagine the type of insanity this might stir up. (Remember when Missoni madness broke the company's website?)
Target is presenting its new concept to reporters in New York on January 12. Until then, check out the new ads for the Jason Wu collection, which hits stores February 5. Which designers and brands would you like to see Target collaborate with next?
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Naughty Needles: Sexy, Saucy Knits for the Bedroom and Beyond - is a brilliant book and a great present. It totally and utterly rocks.
Patterns include clamshell bikini's, tassled g strings, a whip and and even a fetish gag. You simply must check it out!
Your Grandmother would be so proud if you took up knitting - but would she say if she saw what?


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My boy Chris gotta stay alert and aware at all times fam.
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Ernest Wallace
New Charges Against Hernandez Associates
A Bristol County Grand Jury has returned separate indictments bringing new charges against two of the alleged associates of former New England Patriots star Aaron Hernandez.
The Bristol County District Attorney's Office says the indictments were handed down late this afternoon, and charge Carlos Ortiz and Ernest Wallace, both of Bristol, Connecticut, with murder in connection to the June 2013 slaying of Odin Lloyd
Wallace's Attorney Seeks More Info On Accessory Charge
Cousin Granted Bail In Hernandez Case
Hernandez Associate Carlos Ortiz Arraigned In Fall River
An associate of Aaron Hernandez has pleaded not guilty to an accessory to murder charge related to the case against the former New England Patriots player.
Carlos Ortiz was arraigned Friday in superior court following his indictment on a charge of accessory to murder after the fact in the killing of Odin Lloyd.


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on July 31, 2009 Source: Policy Dialogue on Entrepreneurship
That was the title of the July 20 event of the New America Foundation, in which the Kauffman Foundation's Bob Litan laid out some principles to provide a sense of direction in the heavy debate on whether innovative entrepreneurship lies in the hands of government or entrepreneurs. The equation the Kauffman Foundation proposes is rather simple: entrepreneurs = recovery. Litan said, "The next big thing is fueled by entrepreneurs, not big firms." He talked about numerous pro-growth policy reforms, including health care. Litan highlighted that healthcare reform done right would offer security to the risk-taking entrepreneur.The event was an open discussion proposing other key platforms to spur innovation for the next economic frontier —from broadband to immigration to electrical innovation. Editor-in-Chief at Washington Monthly, Paul Glastris, referenced a recent report by the Information Technology and Innovation Foundation (ITIF) which revealed that the U.S. ranked in sixth among 40 countries and regions, based on 16 indicators of innovation and competitiveness. However, in terms of innovative growth, the U.S. staggered in last place. As an example, Glastris argued that compared to the rest of the world, internet connections here are slow and expensive. Australia's internet access is three times better; France is nine times more efficient; and Japan is twenty one times better. Glastris also talked about the "reverse brain drain" and proposed creating incentives for foreign talent to remain in the U.S.Mariah Blake, editor at Washington Monthly, emphasized the lack of innovation in the electricity sector in which the outdated tools and processes of today have remained unchanged since the 1930s. In turn, she cited the many opportunities for efficiency, economic growth, and sustainability through incentives that could introduce a new wave of green entrepreneurs. The overall consensus was that entrepreneurs hold the golden key to the exit doors of the economic recession, yet without the leverage of policymakers, the entrepreneurial path becomes a risky road less traveled.
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Chris Higashi
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Chris Higashi is program manager of the Washington Center for the Book at the Seattle Public Library, where she has worked since 1992. She co–founded and directs "Seattle Reads," the Library's widely emulated One Book community reading program.
Chris coordinates the annual Washington State Book Awards, A. Scott Bullitt Lecture in American History and Living History Series, among other literary and humanities programming. In partnership with independent bookstores, she hosts a reading series featuring international, national and local authors.
She served on the board of Copper Canyon Press, preeminent nonprofit publisher of poetry, from 1994 to 2011. Chris has been a bookseller and was a law firm administrator for Wickwire, Lewis, Goldmark and Schorr. She is a native of Seattle.


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Reviewed Italian Wedding Cake
Aug 29, 2012 in Food Network Community Toolbox on FoodNetwork.com
"AWFUL!! This cake fell apart completely, I'm not a rookie baker but my daughter wanted this for her birthday...well off to Publix for me. I have no idea what I did wrong!""