Mervyn Couper – WA

Mervyn Couper was  82 years old when he was diagnosed.
He first noticed breathing became difficult when reaching into get cartons of milk from a Supermarket refrigerated display unit
When a routine chest X-Ray many years earlier showed a small nodule in the upper right lobe, he was advised to have routine Cat Scans each year. A subsequent routine Cat Scan done in March 2012 suggested that there was infection in the lung. He felt Ok.  A stethoscope examination of the lungs showed no congestion, so his local doctor and he ignored the radiologist comment. In April when walking up a small hill, which normally would not represent any problems, he found himself struggling to breath.  An X-Ray of the chest was performed to check the heart, which was OK. . He was asked to consult with his Cardiologist, who  considered the event was not caused by the heart and referred him to a Respiratory Physician whom he trusted.
 
Initially the Respiratory Physician considered the problem was caused by a mucus plug in the lung. He arranged for a lung function test which did not show any abnormality. By this time Mervyn was finding himself coughing more than normal, producing small quantities of mucus and having occasional night sweats. He was asked to try to collect three sputum samples for pathology testing . The mucus samples were comprised, but there was an indication of  bacteria in the mucus. Another Cat Scan was performed which suggested NonTuberculosis Mycobacteriam (NTM) infection. More samples of sputum were examined and the diagnosis of Mycobacteriam Aviun Complex (MAC) confirmed in December 2012. Mervyn Couper considered his age makes treatment problematic and decided to live with the infection and not to attempt treatment.
 
For the first 6 months, his largely failed attempts to clear his airways was frustrating him. He discovered normal physiotherapists told him they had minimal knowledge to help him. He also discovered that physiotherapists with MAC experience are VERY VERY rare.   After six months trying, he got an appointment with a Respiratory Physiotherapist. Over the next six months he started to make progress, but thew quanity of mucus cleared was still inadequate. 
Never the less ,for the first twelve months the MAC infection did NOT interfere with his normal activities. Just slowed him up, when doing heavy work.
 
But in the next couple of months, his health deteriorated and he found he was short of breath most of the time. There began an even greater effort  to find better ways of clearing the mucus. 
It soon became evident, if he did not start treatment, the prognosis would be very bleak.
He began taking the three regular (Clarithromycin, Ethambutol, and Rifampicin) antibiotics every day in March 2014. This caused chronic constipation. His vigorous coughing and straining to empty his bowel caused a hernia. The hernia was repaired. Treatment was stopped and restarted frequently during this period. He then had a massive unexpected Hemopytsis (Lung bleed) due him taking blood thinners at the time. The blood thinners was stopped. Soon after a second slightly smaller Hemopytsis occurred.
During this time, treatment had been stopped whilst the repair of the hernia had been done and was healing
 
Treatment was recommenced in August 2014. In the meantime, it was discovered that the constipation was caused by excessive fibre in the diet and taking the Clarithromycin with food.
 
He cleared his airways by inhaling warm, humid air, overnight with a MyAirVo 2 device. In addition he inhaled hypertonic ( 6% ) saline solution with a Pari Sprint Nebulizer attached to an Aerobika  Oscillating Positive Expiratory Pressure Therapy System (OPEP). This method worked worked for 6 months.
 
In February 2015, a mucus analysis. cat scan and lung function test results were reviewed.  It was found the treatment had  reduced the area where the bacteria was active, and stopped further deterioration of the bronchiectisis The lung  function test showed the lungs had lost about 1/2 their initial capacity.
At about this time, inhaling hypertonic saline through an Aerobika was no longer helping to remove the mucus.
However breathing warm humid air overnight for about seven hours, continued to produce a good result for a further month.
 
In January 2015, an infection was observed in the sun damaged skin of the head. The infection was detiremined to be Golden Staph which was alwas also detected in the mucus analysis and a cat scan of the lung.  After a number of  unsuccessful attempts to treat the infection,  an Infection Diseases Physician (Dr Astrid Arellano) prescribed a 10 day course of Moxifloxacin with a body wash of Chlorhexidine for 5 days, to be repeated for 4 months at monthly intervals, plus Mupirocin ointment for the nose and strong mouth wash. The treatment of the external skin was successful,  but Dr Arellano considered the probability of success for the  lung Golder Staph infection is not high .
 
During this time he was losing weight and by March 2015 he had lost 10kg, most of the body fat was gone and the muscles were deteriorating. He was very weak. A dietitian was consulted who reviewed his diet and prescribed supplements. By December 2015, he had returned to a healthy weight, had more energy and was exercising at a Gym every second day. Aerobic exercise combined with shoulder exercises have been very helpful in clearing the airways.
 
In January 2016 the status of the lungs were  reviewed again. The  MAC and Golden Staph bacteria were not detected in the mucus or the cat scan. The lung function results and the bronchiectisis had deteriorated a little.