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My Symptoms:
My symptoms initially included tremendous fatigue, malaise, muscle aches and cramps,
restlessness, inability to sleep, and severe burning in my chest with exertion (due to profound pulmonary small airway disease). The muscle aches and cramps, restlessness, and inability to sleep have largely resolved, but the others remain with a gradual tendency to decrease.
My problem now is that I can't go near, much less work with, any paper or books contaminated by the mold spores. This includes medical books, charts, magazines etc. If I do get exposed, I become ill again for anywhere from a few days to a few weeks, depending upon the intensity and length of exposure.

I found that with each exposure I got, my sensitivity would increase; that is, it would take increasingly smaller amounts of the mycotoxins on the spores to make me ill.

Since my exposure to and intoxication from stachybotrys I have become so sensitized to smoke that I can't go into the operating room because of the smoke generated by the electrocautery. I become very ill and incapacitated with exposure to incredibly small quantities of smoke. Interestingly, before my career in orthopedic surgery, I did complete a residency in pediatrics. More interestingly, I was quite interested in poisoning and toxicity as children are not infrequently poisoned by ingestion of various medications and chemicals. During the residency I wrote a paper titled "Hyperglycemia associated with Diphenylhydantion Intoxication", published in The Journal of Pediatrics. How prophetic that someday I would be affected by some type of toxicity!

My Experience With Stachybotrys Toxicity:
My nightmarish experience began with a gradual onset of symptoms as described above. Mold was discovered in a bathroom of our house. Unfortunately, I didn't understand the significance of that black mold with a rather peculiar odor. When we tried to dry out the moldy areas with fans, as suggested by our local pest control company, my illness rapidly escalated. My family (wife and two boys) was not affected in the least by this mold, nor were any of our visitors.

I soon had to move out of the house; I actually lived in a tent for about one week. As it was summer, it wasn't too bad. I continued to conduct my business as usuall, figuring I could move back in shortly as soon as my contractor had the mold cleaned up. Frankly, my family was beginning to think I was loosing my sanity!

What actually happened from that point on is still a blur in my mind. Since then I have lived in about forty different motel rooms trying to figure out how to get away from this toxic stuff. (The links at the top of this page to 'posts' and 'path' will better help the reader to understand this.) Also, I have lived in four new houses, the most recent being devoid of any carpet, rugs, stuffed furniture etc. It is basically sparsely furnished with a tile floor, no rugs and vinyl window dressings. Additionally, I and my family had to get rid of all of our possessions including, financial records, bank statements, pictures, photographs, photograph albums, clothing, furniture, books (including my entire medical library and journal's collected over a thirty-year period, bedding, kitchenware, silverware, computers, automobiles, desks, chairs, office machines, family heirlooms - everything.

In the middle of this nightmare, I became ill enough to require hospitalization along with a protracted course of steroids (cortisone). The problems I had with long term steroid therapy will take a page or two to describe.

This story is far from complete. I will keep adding, editing and revising until the job is done.

 

What Is The Toxicology Of Stachybotrys?

Toxicologically, S. chartarum can produce extremely potent trichothecene poisons, as evidenced by one-time lethal doses in mice (LD50) as low as 1.0 to 7.0 mg/kg, depending on the toxin and the exposure route. Depression of immune response, and hemorrhage in target organs are characteristic for animals exposed experimentally and in field exposures (Ueno, 1980; Jakab et al., 1994).
While there are insufficient studies to establish cause and effect relationships between Stachybotrys exposure indoors and illness, including acute pulmonary bleeding in infants, toxic endpoints and potency for this mold are well described. What is less clear, and has been difficult to establish, is whether exposures indoors are of sufficient magnitude to elicit illness resulting from toxic exposure.

Some of these difficulties derive from the nature of the organisms and the toxic products they produce and varying susceptibilities among those exposed. Others relate to problems common to retrospective case control studies. Some of the difficulties in making the connection between toxic mold exposures and illness are discussed below.

Johanning, (1996) in an epidemiological and immunological investigation, reports on the health status of office workers after exposure to aerosols containing S. chartarum. Intensity and duration of exposure was related to illness. Statistically significant differences for more exposed groups were increased lower respiratory symptoms, dermatological, eye and constitutional symptoms, chronic fatigue, and allergy history. Duration of employment was associated with upper respiratory, skin and central nervous system disorders. A trend for frequent upper respiratory infections, fungal or yeast infections, and urinary tract infections was also observed. Abnormal findings for components of the immune system were quantified, and it was concluded that higher and longer indoor exposure to S. chartarum results in immune modulation and even slight immune suppression, a finding that supports the observation of more frequent infections.

Three articles describing different aspects of an investigation of acute pulmonary hemorrhage in infants, including death of one infant, have been published recently, as well as a CDC evaluation of the investigation (Montaña et al., 1997; Etzel et al., 1998; Jarvis et al., 1998; MMWR, 2000; CDC, 1999). The infants in the Cleveland outbreak were reported with pulmonary hemosiderosis, a sign of an uncommon of lung disease that involves pulmonary hemorrhage. Stachybotrys chartarum was shown to have an association with acute pulmonary bleeding. Additional studies are needed to confirm association and establish causality.

Animal experiments in which rats and mice were exposed intranasally and intratracheally to toxic strains of S. chartarum, demonstrated acute pulmonary hemorrhage (Nikkulin et al. 1996). A number of case studies have been more recently published. One involving an infant with pulmonary hemorrhage in Kansas, reported significantly elevated spore counts of Aspergillus/Penicillium in the patient’s bedroom and in the attic of the home. Stachybotrys spores were also found in the air of the bedroom, and the source of the spores tested highly toxigenic (Flappan et al., 1999). In another case study in Houston, Stachybotrys was isolated from bronchopulmonary lavage fluid of a child with pulmonary hemorrhage. (Elidemir et al., 1999), as well as recovered from his water damaged-home. The patient recovered upon removal and stayed well after return to a cleaned home. Another case study reported pulmonary hemorrhage in an infant during induction of general anesthesia. The infant was found to have been exposed to S. chartarum prior to the anesthetic procedure (Tripi et al., 2000). Still another case describes pulmonary hemorrhage in an infant whose home contained toxigenic species of Penicillium and Trichoderma (a mold producing trichothecene poisons similar to the ones produced by S. chartarum) as well as tobacco smoke (Novotny and Dixit, 2000).

What Are The Toxic Effects Of Molds?

Molds can produce other secondary metabolites such as antibiotics and mycotoxins. Antibiotics are isolated from mold (and some bacterial) cultures and some of their bacteriotoxic or bacteriostatic properties are exploited medicinally to combat infections.
Mycotoxins are also products of secondary metabolism of molds. They are not essential to maintaining the life of the mold cell in a primary way (at least in a friendly world), such as obtaining energy or synthesizing structural components, informational molecules or enzymes. They are products whose function seems to be to give molds a competitive advantage over other mold species and bacteria. Mycotoxins are nearly all cytotoxic, disrupting various cellular structures such as membranes, and interfering with vital cellular processes such as protein, RNA and DNA synthesis. Of course they are also toxic to the cells of higher plants and animals, including humans.

Mycotoxins vary in specificity and potency for their target cells, cell structures or cell processes by species and strain of the mold that produces them. Higher organisms are not specifically targeted by mycotoxins, but seem to be caught in the crossfire of the biochemical warfare among mold species and molds and bacteria vying for the same ecological niche.

Not all molds produce mycotoxins, but numerous species do (including some found indoors in contaminated buildings). Toxigenic molds vary in their mycotoxin production depending on the substrate on which they grow (Jarvis, 1990). The spores, with which the toxins are primarily associated, are cast off in blooms that vary with the mold’s diurnal, seasonal and life cycle stage (Burge, 1990; Yang, 1995). The presence of competitive organisms may play a role, as some molds grown in monoculture in the laboratory lose their toxic potency (Jarvis, 1995). Until relatively recently, mold poisons were regarded with concern primarily as contaminants in foods.

More recently concern has arisen over exposure to multiple mycotoxins from a mixture of mold spores growing in wet indoor environments. Health effects from exposures to such mixtures can differ from those related to single mycotoxins in controlled laboratory exposures. Indoor exposures to toxigenic molds resemble field exposures of animals more closely than they do controlled experimental laboratory exposures. Animals in controlled laboratory exposures are healthy, of the same age, raised under optimum conditions, and have only the challenge of known doses of a single toxic agent via a single exposure route. In contrast, animals in field exposures are of mixed ages, and states of health, may be living in less than optimum environmental and nutritional conditions, and are exposed to a mixture of toxic agents by multiple exposure routes. Exposures to individual toxins may be much lower than those required to elicit an adverse reaction in a small controlled exposure group of ten animals per dose group. The effects from exposure may therefore not fit neatly into the description given for any single toxin, or the effects from a particular species, of mold.

Field exposures of animals to molds (in contrast to controlled laboratory exposures) show effects on the immune system as the lowest observed adverse effect. Such immune effects are manifested in animals as increased susceptibility to infectious diseases (Jakab et al., 1994). It is important to note that almost all mycotoxins have an immunosuppressive effect, although the exact target within the immune system may differ. Many are also cytotoxic, so that they have route of entry effects that may be damaging to the gut, the skin or the lung. Such cytotoxicity may affect the physical defense mechanisms of the respiratory tract, decreasing the ability of the airways to clear particulate contaminants (including bacteria or viruses), or damage alveolar macrophages, thus preventing clearance of contaminants from the deeper lung. The combined result of these activities is to increase the susceptibility of the exposed person to infectious disease, and to reduce his defense against other contaminants. They may also increase susceptibility to cancer.

Because indoor samples are usually comprised of a mixture of molds and their spores, it has been suggested that a general test for cytotoxicity be applied to a total indoor sample to assess the potential for hazard as a rough assessment (Gareis, 1995).

The following summary of toxins and their targets is adapted from Smith and Moss (1985), with a few additions from the more recent literature. While this compilation of effects does not describe the effects from multiple exposures, which could include synergistic effects, it does give a better idea of possible results of mycotoxin exposure to multiple molds indoors.

• Vascular system (increased vascular fragility, hemorrhage into body tissues, or from lung, e.g., aflatoxin, satratoxin, roridins).
   
• Digestive system (diarrhea, vomiting, intestinal hemorrhage, liver effects, i.e., necrosis, fibrosis: aflatoxin; caustic effects on mucous membranes: T-2 toxin; anorexia: vomitoxin.
   
• Respiratory system: respiratory distress, bleeding from lungs e.g., trichothecenes.
   
• Nervous system, tremors, incoordination, depression, headache, e.g., tremorgens, trichothecenes.
   
• Cutaneous system : rash, burning sensation sloughing of skin, photosensitization, e.g., trichothecenes.
   
• Urinary system, nephrotoxicity, e.g. ochratoxin, citrinin.
   
• Reproductive system; infertility, changes in reproductive cycles, e.g. T-2 toxin, zearalenone.
   
• Immune system: changes or suppression: many mycotoxins.

It should be noted that not all mold genera have been tested for toxins, nor have all species within a genus necessarily been tested. Conditions for toxin production varies with cell and diurnal and seasonal cycles and substrate on which the mold grows, and those conditions created for laboratory culture may differ from those the mold encounters in its environment.

Toxicity can arise from exposure to mycotoxins via inhalation of mycotoxin-containing mold spores or through skin contact with the toxigenic molds (Forgacs, 1972; Croft et al., 1986; Kemppainen et al., 1988 -1989). A number of toxigenic molds have been found during indoor air quality investigations in different parts of the world. Among the genera most frequently found in numbers exceeding levels that they reach outdoors are Aspergillus, Penicillium, Stachybotrys, and Cladosporium (Burge, 1986; Smith et al., 1992; Hirsh and Sosman, 1976; Verhoeff et al., 1992; Miller et al., 1988; Gravesen et al., 1999).

What Are The Symptoms And Health Effects Of Mold Intoxification?

In general, exposure to mold spores and pieces can result in allergic reactions, infections, or toxic (poisonous) effects. These health effects are the result of exposure by skin contact, ingestion, or breathing the mold. Stachybotrys has been studied for a number of years, with most of the early studies done on animals. Stachybotrys exposure is linked to allergic reactions. People in buildings with active stachybotrys growth generally experience symptoms that include irritation and watering of the eyes and nose. Coughing and skin irritation are also allergic reactions commonly associated with stachybotrys exposure. Animal studies clearly show that stachybotrys exposure, even in low levels, suppresses the immune system. Anecdotal data clearly supports this immuno-suppressive capability in humans. As such, exposed individuals are often susceptible to bacterial and viral infections such as the flu.The reason that stachybotrys is of such concern is the medical evidence that has proven that this mold has toxic properties. Stachybotrys produces a mycotoxin (i.e., poison from a fungus) named trichothecenes.

When inhaled or ingested stachybotrys can cause:

• Sore/hoarse throat
   
• Cold and flu symptoms (headaches, slight fever, and muscle aches)
   
• Nose bleeds
   
• Tingling or burning of nose, mouth, and perspiration areas (under the arms or
  between the legs)
   
• Chronic fatigue
   
• Dizziness
   
• Nausea/vomiting
   
• Memory loss
   
• Attention deficit/concentration problems
   
• Personality changes such as irritability or depression
   
•  Neurological disorders such as tremors
   
• Hair loss
   
• Coughing with blood
   
• Bleeding in the lungs (hemosiderosis)
   
• Damage to internal organs including blood, liver, kidneys, and lungs

Although not supported by definitive studies at this point, there are some concerns about stachybotrys exposure promoting cancer. The symptoms and health effects related to stachybotrys depend on an individual's pre-existing health situation, length of exposure, and the amount of stachybotrys in the environment. Because of this, different people in the same situation, even family members, may experience different sets and severity of symptoms.

What Tests Can Be Done To Help Diagnose Stachybotrys Toxicity?

No single medical test can pinpoint the level of exposure or body damage caused by stachybotrys. Proper medical care and professional decision making is necessary to assure that the affected individual is treated properly.

Many physicians believe that the following tests are appropriate in conducting a medical screening for stachybotrys:

• Complete medical exam
   
• Chest x-ray · Pulmonary function test
   
• Complete red and white blood cell count
   
• Blood sedimentation rate
   
• Stachybotrys specific RAST antibody test
   
• Immunoglobulin panel
   
• Immune competence tests

Doctors should be encouraged to discuss the environmental situation with the industrial hygiene professionals who have conducted sampling in the building in question etc. .

What Are The Recommendations of Doug Haney, PhD. For Toxic Testing?

We have found that a blood-serum test cultured with agar agents known as the Multiple Antigen Simultaneous Test (MAST) CLA, Environmental IgG, Panel #15, conducted by Hitachi Chemical Diagnostics,® Incorporated of Mountain View, California, and a genetic Polymerase Chain Reaction (PCR) testing process conducted by ImmunoLabs,® Inc., in the Los Angeles, are both very helpful in detecting fungi levels in the human body. There are also certain blood-serum tests available through blood laboratories for the Stachybotrys species. These can be expensive. Consult with, and work through your medical doctor if you are going to have them ordered.

Can anything be saved? Can I save any of my family heirlooms? I have Stachybotrys. I lived in it for 6 months. Have left everything behind but wondering if I can save anything.

The answer to your question is complex. It largely depends upon those items which you wish to save and to a lesser extent the type of illness the Stachybotrys is causing you. Also, there are theoretical considerations and considerations gained from practical experience.

On a practical basis, if you are simply allergic to the mold than you could be more aggressive in saving items. However, if you suffer from toxicity, like many of us do, then it is my earnest recommendation that you be extremely cautious in trying to save anything or you will probably deeply regret it. In my experience, after disposing three automobiles and three houses, the only items that can be reasonably 'safely' retained are those that meet these requirements:

1. they are non-porous (they have durable, smooth surfaces)
    
2. they contain no cellulose or other organic material such as paper, cardboard, wood, leather, cotton, wool, wall board etc.
    
3. they could be thoroughly washed in a washing machine.
    
4. Such items would include glass ware, dishes, silverware, CD ROMS, coins etc.
   There are at least two important considerations when one deals with this mold.
    

(1). How long do the spores remain potentially viable once they are released from the living stachybotrys mold?

The best answer I have received regarding this is: "Stachybotrys spores can survive for at least a year after release. However, the viability does decline with time. The environment they are in will affect survival and rate of decline."

Thus, any item you try to salvage can carry some spores that potentially could germinate, under the right conditions, in your new environment.

(2). How long do the mycotoxins on stachybotrys spores remain potent after the spores are discharged into the air?

The best answer I have received regarding this is: "The trichothecene toxins are very stable. Again the environment matters, if stored dry, there is little loss of activity for a year."

Thus, if mycotoxins on the mold cause you symptoms, if you carried some of the dead spores on the material you tried to salvage, that material could continue to make you ill for as long as the mycotoxins remained potent.

The answers, in quotations, were kindly provided by Mr. Stephen Vesper of the EPA.
Finally, there is no question that Five percent sodium hypochlorite (bleach) will kill live mold. But, that doesn't solve your problem. You need to denature the mycotoxins on the mold spores that are on your contaminated material. This requires a substance that can denature the mycotoxins, while preserving the material being treated. I haven't found the answer to this question with any degree of reasonable certainty.

I have tried to salvage some clothing, but it has been difficult, risky, time consuming and in many cases failed, causing me a great deal of grief. I managed to salvage some super silk shirts (100% polyester) by repeated washings. In retrospect, it probably wasn't worth the effort. Very porous clothing, such as sweaters, even of the synthetic variety, don't seem to respond to a reasonable number of washings, at least in my experience. Using bleach on these clothing doesn't seem to help insofar as toxicity is concerned. And, forget paper products, such as books, articles, magazines, miscellaneous papers etc.

What are your symptoms and what has been effective treatment for you?

Symptoms included tremendous fatigue, malaise, muscle aches and cramps,
restlessness, inability to sleep, and severe burning in my chest with exertion
(due to profound pulmonary small airway disease).

My problem now is that I can't go near, much less work with, any paper or books
contaminated by the mold spores. This includes medical books, charts, magazines
etc. If I do get exposed become ill again anywhere from a few days to a few
weeks, depending upon the intensity and length of exposure.

I found that with each exposure I got, my sensitivity would increase; that is,
it would take increasingly smaller amounts of the mycotoxins on the spores to
make me ill.

Also, I have become sensitized to incredibly small quantities of smoke. If I
get a few whiffs of smoke from a cigarette, cigar or chimney (smoke from a
fireplace), I'll get symptoms of fatigue, malaise, flu-like symptoms and eve
more severe burning in the chest with exertion for a few hours to a day or two.

Regarding treatment, the five most effective measures are:

1. avoidance of living mold
    
2. avoidance of the mold spores
    
3. avoidance of contaminated items
    
4. avoidance of smoke
    
5. avoidance of fatigue (getting enough sleep)

The next five measures are:

    6.   inhalation ipatropium bromide (four times daily in a nebulizer)

    7.   inhalation albuterol sulfate (four times daily in a nebulizer)

    8.   inhalation fluticasone propionate 500 mcg and samletrol 50 mcg (powder), 2
          puffs daily (Advaid Diskus 500/50)

    9.   Theophylline 200-300 mg daily in divided doses

   10.  Being careful to get enough potassium and calcium (combination of diet & pills).

1. Determine if you and/or you family have allergic or toxic symptoms.
    
2. If there is any question of toxicity whatsoever, then you and your family should exit your current environment immediately; and, do not bring any of your old possessions, especially including clothing, books, furniture, bedding etc. (this will be further discussed in another post).
    
3. You should seek medical attention from a qualified expert, but getting out of the environment should be your top priority.
    
4. Persons affected by mold (especially the mycotoxins of mold) tend to severely
   underestimate the dangers from their exposure.
    
5. They tend to make their move far too late.
    
6. When they are eventually forced to move, they tend to make the mistake of taking their possessions - especially ones made of paper, cardboard, animal fibers (clothing), leather, and similar materials which the mold can readily grow on. This causes cross contamination of their new environment, and the process repeats itself.
    
7. If you are symptomatic form your mold exposure, get away from it. You can replace the
   material things, but you may not be able to replace your health!

What is the difference between an allergy to mold and a toxicity from mold?

Allergic symptoms to mold would include sneezing; a running and itchy nose; watering and itching of the eyes; nasal stuffiness; respiratory symptoms such as wheezing and coughing, especially in asthmatics; itching of the skin.

Toxic symptoms are due to mycotoxins on the mold spores. They can include: memory loss ; attention deficit/concentration problems ; personality changes such as irritability or depression; neurological disorders such as tremors; tingling or burning of nose, mouth; chronic fatigue; dizziness; nausea/vomiting; bleeding in the lungs; suppression of the immune system; headache; flu-like symptoms; red eyes (without watering or itching); incoordination; muscle spasms and cramps; damage to internal organs. Toxic symptoms from these mycotoxins have similarities to toxic symptoms from poisoning. Stachybotrys spores produce multiple mycotoxins, including trichothecenes. Trichothecenes have been produced commercially for use in biological warfare. These are strong neurotoxins. Mycotoxins are nearly all cytotoxic, disrupting various cellular structures such as membranes, and interfering with vital cellular processes such as protein, RNA and DNA synthesis

If you were to meet a person suffering from allergy to mold, that person would most likely complain of symptoms similar to those of ‘hay fever’. Those symptoms are detailed above under “allergic symptoms”. The symptoms would most likely be described as annoying (with varying degrees of annoyance); they would not, however, be described as devastating. Their symptoms would be rather straight forward , easily observable and easily understandable.

If you were to meet a person suffering from toxicity due to mold mycotoxins, your first impression might be that the person is affected by a mental problem. Your first thought might be that the person would be best off consulting a psychiatrist or a psychologist. The person might have a lot of vague symptoms – symptoms way out of proportion to what you could observe – symptoms that might be difficult for the affected person to explain and for you to understand. But, the underling theme, if you listened carefully, would be that of toxicity. Most likely the toxic person would complain of extreme fatigue, weakness, tiredness, flu-like symptoms, and often respiratory problems: but not usually coughing or wheezing. Instead, he/she would complain of terrible burning or soreness in his/her lungs, possibly aggravated with exertion or exercise. And, instead of telling you that the experience was one of annoyance (to a lesser or greater degree) as allergy sufferers would tell you, the toxic sufferer would more likely describe her/his experience as a hellish nightmare.

The toxic sufferer’s behavior would more likely be that of a frantic effort to get away from the contaminated source and an almost paranoiac effort to rid themselves of contaminated materials. This is in stark contrast to the allergic sufferer who would most likely find the offending mold to be more of a nuisance rather than a substance sent from hell.

What is more specific advice regarding continuing toxic mold exposure?

1. First, and foremost, if this mold is making you and /or your family old ill, my advice is to get out of that environment now! Continued exposure may increase the chances for a
chronic problem and/or permanent damage. Go to a motel if necessary, while you are
waiting for your new quarters.

2. You must be sure to accurately identify the mold(s); they could include Stachybotrys and/ or other toxic molds. Make sure that the lab testing your environment is familiar with the identification of stachybotrys and/or other toxic molds.

3. Don't disturb the mold or try to treat it yourself. If it is stachybotrys and you disturb it, you may cause the mold to sporulate (produce a bioaerosol).The spores can be extremely toxic and damaging to susceptible individuals.

4. If it is stachybotrys, (and this may be also true for other toxic species) don't take anything with you when you move. This may sound harsh, but if you bring items contaminated with stachybotrys spores into your new environment you still may stay sick and you may have to repeat the process all over. Although, the spores are not living, they are much more toxic than the living mold as they carry strong mycotoxins which can cause all the symptoms you describe. The items I have found to be especially bad are all paper products including books, magazines, files of papers, cardboard, news papers and so forth. Also, the mold clings to fabric such as stuffed furniture, bedding, carpet, and clothing. You may get away with items that have smooth surfaces and that are easily washable such as dishes, pots, pans, glasses, silverware etc.

5. The precautions I mentioned in item #4 are from my own personal experience with
stachybotrys and may not apply to other molds or all individuals exposed to stachybotrys. However, if you do find stachybotrys, and as both you and your child are quite symptomatic, I would give very serious thought to item #4. Also, I know that there are others exposed to stachybotrys who have had similar experiences.

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