“We should be able to enjoy living near coastal areas without fear of mold issues. Proper assessment and care of indoor environments makes all the difference!”
Assessment Of Mold In Indoor Environments
By John H, Albrecht, Albrecht Consulting, LLC
So, you say you have mold? Or you suspect mold is in your house, and you do not know what caused it? Should you have it tested? If so, whom should you call?
These are all questions that may plague the average homeowner, when faced with an unknown allergen. Many clients believe it must be “that mold stuff I saw on TV or on that full page newspaper ad I saw the other day.” I hope the following helps you make more of an educated decision, when determining your particular course of action.
What are you reacting to? – First of all, are you sure it is mold that is your main concern or is it possibly another environmental trigger? Have you been tested for other allergens? A fair analogy may be changing the oil in your car because it “knocks” going up a hill, when all along it may be a timing problem, which the oil change will not fix.
Moisture – Addressing the source of the problem – Now that you know you are reacting to mold, you need to be aware that many well known websites say to address moisture as the main culprit. Think about your house, and make a note of any moisture sources that would contribute to mold growth. Examples include water leaks, which are obvious, but a majority of complaints in buildings stem from VAPOR LEAKS.
Who should I hire? Know your Inspector – A competent engineer or building inspector, who can look objectively at your building, and is there as an unbiased expert, should be hired to assess the cause and origin of moisture intrusion. Ask questions as to their licensing and the years of experience the inspector has before hiring the consultant. Once the moisture issue is properly diagnosed, a plan can be implemented for mitigation of the moisture, and possibly mold if encountered. Too many times clients will hire a tradesman to look at moisture issues or they will see an ad in the paper for a “free crawl space inspection”. If an air conditioning (HVAC) technician arrives to do an inspection of the building, what deficiencies do you think he will be most focused on?
Visual Inspection – Now that you have selected your inspector, the inspection can begin. A good inspection should begin within the structure to look for obvious signs of problems. It should proceed to the attic, then should proceed to the crawl space. If you are testing that day, don’t allow the inspector to enter or open the attic. They will bias the sampling. A good diagnostician will typically find issues with a building during the visual inspection, if there is a mold issue. If it is a vapor issue, plan on it being a more difficult assessment.
Testing – There is significant debate about what type, if any, of testing to use for indoor air quality testing. The Indoor Air Quality Association Annual Conference in 2007 cited particle counting by instrumentation as a viable means of assessing problematic areas.
For air sampling, there are several types of cassettes for capturing particles. Some cassettes use higher flow for capture of particulate, and some specialize in a lower flow for sampling. Some hygienists will like to test using agar plates, so they can identify the species of mold present. It’s all very confusing, but it goes back to picking the person you are most comfortable with and matching the level of assessment with the need for data.
Report – The report should identify the visual findings and should discuss the laboratory findings, if samples were taken. Conclusions and recommendations should be included that address the main problem, as the diagnostician sees it, and long-term solutions for repair. In some cases, the consultant will be able to estimate the cost for mold cleanup, based on their experience in the field. This can be very helpful, so ask the inspector if they have any experience with cleanup, and if so, in what capacity.
Cleanup – Finally, the Institute of Inspection Cleaning Restoration Certification (IICRC) publishes an industry standard for mold cleanup called IICRC Standard S520. This standard succinctly addresses the requirements of parties involved in the cleanup of mold. The objective is to return the site to a Condition 1, Normal Fungal Ecology. You can find this document at www.IICRC.org.
Post-cleanup Sampling – Current real estate law in South Carolina mandates disclosure of mold in real estate transactions. If you have a mold incident, you will need documentation from the independent consultant to verify to the buyer that it was handled properly. This will typically involve more testing, so be prepared to have the consultant close at hand to see the project through. It will save you money in the long run.
For additional information about mold exposure, please see the article, Household Mold: Toxin? Infection? Allergy?
ABOUT THE AUTHOR:
Mr. John Albrecht received his B.S. in Civil Engineering from the Citadel in 1985 and has been a Professional Engineer licensed in South Carolina (License #13896) for the last 18 years. He was an Environmental Engineer for the Department of Defense from 1987-1991, and began working in the private sector in 1991. Since 1993, Mr. Albrecht has managed his own environmental consulting firm in Charleston. Since 2000, the firm has focused solely on indoor air quality, building science, and energy efficiency issues. The firm was awarded the Emerging 10 Award for the Charleston Metro Chamber of Commerce in both 2003 and 2004. Mr. Albrecht holds accreditation from the American Indoor Air Quality Council as a Certified Indoor Environmental Consultant (CIEC).
The Effects of Toxic Molds on Personality and Brain Functioning
By Nancy A. Didriksen, Ph.D., Neuropsychologist
This sobering article by a licensed and experienced Neuropsychologist is meant to emphasize the seriousness of chronic toxic mold exposure. Mold toxicity requires proper diagnosis and appropriate treatment, since it is now being shown that mold mycotoxins can cause chronic, toxic brain injury in exposed individuals.
There are many types of brain injuries. These may occur as a result of blows to the head, gunshot wounds, accidents, strokes, sports injuries, electrical and lightning injuries, migraine headaches, vascular problems, degenerative diseases such as Alzheimer’s and Parkinson’s, neurological diseases such as multiple sclerosis, and from normal pressure hydrocephalus. Brain injury may also occur as a result of infectious processes such a HIV infection and AIDS, herpes simplex, Lyme disease, from a variety of brain tumors, chemotherapy, radiation therapy, oxygen deprivation, carbon monoxide poisoning, metabolic and endocrine disorders such as diabetes or hypothyroidism, and toxic conditions such as exposure to excessive amounts of alcohol, solvents, heavy metals, pesticides, and street drugs.
More recently, the effects of toxigenic molds on brain functioning are being studied. There have been numerous studies performed on other types of brain injuries and relatively few studies to date on the effects of the molds which give off toxic substances called mycotoxins.
However, from the studies that have been performed and the observations that have been made of patients who have been exposed to toxigenic molds and evaluated, a pattern of deficits is being revealed. This pattern of deficits is strikingly similar to the pattern of deficits observed in individuals who have been exposed to other neurotoxic substances, such as pesticides, solvents, and heavy metals, thereby suggesting that these molds have neurotoxic properties.
Dr. Marshall Mandell reported brain reactions, including an inability to concentrate and confusion, during testing with various mold extracts in 1976. Other studies performed, beginning in 2001, have reported chronic, toxic brain injury apparently related to exposure to toxigenic fungi. Personality changes have also been observed.
Patients being tested undergo a variety of neuropsychological and personality tests to determine exactly what areas of cognitive functioning are being affected. Deficits are found primarily on measures of higher cortical functioning (executive functions) including the ability to regulate one’s behavior, plan, solve problems, reason in an abstract manner, and initiate actions.
A decline in general intellectual functioning as measured by IQ tests has also been observed. Deficits are generally on measures of information processing speed, attention and concentration, and perceptual organization. Verbal abilities are not as adversely affected.
Deficits in memory functioning are also observed, particularly in incidental memory. Incidental memory is like the memory requirements of everyday life when one is simply expected to remember information without being specifically told to recall the information. Memory for visual information is slightly more impaired than verbal memory. Overall, scores on a formal measure of memory fall close to the average for the population. However, what is important to remember is that the average educational level for the group of patients being observed is very close to a four-year college degree. Scores for college level individuals are usually expected to be in the high-average to superior ranges on neuropsychological tests.
Overall, the majority of patients score in a mildly impaired range on the most widely used and researched neuropsychological test battery in the U.S., the Halstead-Reitan Neuropsychological Battery, despite relatively good IQ scores. Scores also suggest that brain damage is diffuse (all over the brain), rather than localized to one specific area.
Patients experience a variety of physical, psychological, and neurocognitive symptoms. The following are the most frequently reported symptoms on the Physical Symptom Checklist by patients exposed to toxigenic molds: easily fatigued, low energy, muscle weakness, trouble remaining asleep, aches and pains, sexual dysfunction, headaches, trouble falling asleep, sinus discomfort, and heart problems. The top 12 psychological symptoms include present performance inferior to prior performance or level of functioning, overwhelming exhaustion, fatigue or weariness, “this is not me”, difficulty getting started in the morning, “cloudy, foggy, spacey”, worry about bodily dysfunction, diminished self-confidence, tension, loss of interest in sexual activity, inability to cope well with daily or other stressors, feeling of losing control of one’s life and destiny, and loss of interest in activities. The most frequently reported neurocognitive symptoms include decreased immediate and short-term memory, decreased concentration, decreased attention, difficulty remembering the names of things or people, losing words, intellectual inefficiency (hard to think), easily distracted, decreased comprehension, poorly organized (“scattered”), and losing train of thought.
Psychological and personality/behavioral functioning is also affected as indicated by the number of psychological symptoms endorsed on the checklist and by the results on personality tests. Patients exposed to toxigenic molds indicate that they are more confused and fatigued and sometimes more depressed, anxious, and angry than they were prior to the toxic exposure. They also report a reduced level of vigor and activity. However, overall they appear generally psychologically healthy, with depression, anxiety, and poor coping ability secondary to ill health which sometimes results in a disabled condition.
Those exposed to toxigenic molds also experience a variety of losses to which they must adjust, including loss of home and belongings, loss of income, loss of ability to function as they had in the past in all areas, loss of personal freedom, and loss of relationships. Exposure to toxigenic molds, like other neurotoxic substances, results in the reduction of the level of comfort, achievement, satisfaction, and effectiveness of the majority of individuals exposed.
ABOUT THE AUTHOR:
Dr. Nancy Didreksen received her Ph.D. in Health Psychology and Behavioral Medicine from the University of North Texas in 1986, with a research emphasis in psychoneuroimmunology. As an Adjunct Professor of Psychology at the University of North Texas, she has continued research into the adverse neuropsychological effects of environmental toxins and has published approximately 40 professional papers. For the past 25 years, she has also maintained a private practice in psychology in Richardson, Texas, where she evaluates and treats environmentally and chronically ill patients, in both in-patient and out-patient settings.
Luke Curtis, my co-author of the review article on the Adverse Health Effect of Indoor Mold, published in the Journal of Allergy and Clinical Immunology, wrote another important paper on the effects of mold that I would like to share with you.
My experience with hundreds of patients exposed and injured by mold demonstrated the multi-systemic nature of toxic mold exposure. However, I never fully realized the pathophysiology of these effects. Luke and his co-authors demonstrated that there is a major imbalance and dysfunction to the endocrine system specifically to growth hormone, thyroid, and the adrenal hormones.
To be specific, 51% were growth hormone deficient, 81% were thyroid deficient, and 75% were ACTH deficient. All of the seventy-nine patients were fatigued and 94% had chronic fungal sinusitis. In all of the deficient patients who were given supplemental growth hormone, thyroid, and cortisol, the fatigue was improved.
Of special interest to me was that only seventeen out of seventy-nine patients were aware of being mold exposed.
This paper documents what I always say, “Many physicians do not have the foggiest idea of what is wrong with a patient.” The field of Environmental Medicine is a new and exciting approach to the care of complex ill patients. We are trained and experienced to try and find the causes of disease.
In our practice, we see a large number of hormone deficient patients identified by hormone testing. Now, after reading Luke’s paper, I have added Insulin Growth Factor One (IgF1) to our evaluation of sick, tired patients to identify growth hormone deficiency. Although doing an endocrine work up is an additional expense, it is worth it if you identify the cause and can treat it successfully.
Treating deficient patients with Human Growth Hormone (HGH) is not as easy or as reasonable as the cost of thyroid or adrenal hormones. But if you are dragging and just not recovering from your chronic debilitating illness, a trial for one to three months may be well worth it. Unlike the other hormones that can be taken orally, growth hormone is given like insulin- by daily subcutaneous injections. Up until now, insurance companies have refused to pay for this treatment.
As Luke’s paper points out, there are now only 60,000 people with the accepted diagnosis that are receiving growth hormone. However, if toxic mold is causing this hormone loss, then the number of people who could benefit is closer to 4.8 million. There are secretagogues or mimics of HGH that are a fraction of the cost of the whole hormone and importantly may work almost as well.
Call the office if you would like to discuss this alert with me. Also, CLICK HERE if you would like to read the entire article.
Allan Lieberman, M.D., F.A.A.E.M.
Center for Occupational and Environmental Medicine
MOLD EXPOSURE – MOLD TOXICITY
Mold exposure and mold toxicity are very serious issues that can be effectively diagnosed and successfully treated by the experienced professionals at COEM.
Many studies link exposure to damp or moldy indoor conditions to increased incidence and/or severity of respiratory problems such as asthma, wheezing and rhinosinusitis and even life-threatening systemic infections in immunocompromised persons. Stachybotrys, also known as toxic black mold, produces trichothecenes and other mycotoxins,which can inhibit protein synthesis and induce hemorrhaging disorders. Indoor mold exposure can alter immunological factors and produce allergic reactions. Several studies have indicated that indoor mold exposure can alter brain blood flow, autonomic nerve function, and brain waves, and worsen concentration, attention, balance and memory.
Health officials are increasingly concerned about the dangers of mold in our homes and offices. It is understood that mold (fungi) is capable of causing allergy, infection, and even toxicity in humans. Doctors who are members of the American Academy of Environmental Medicine have known for some time that specific molds, in sufficient concentration over a sustained period of time, are potentially detrimental to our health. These doctors have become expert in the diagnosis and treatment of mold-induced medical problems. The physicians at COEM are world class doctors having experience diagnosing mold poisoning and its associated conditions. This includes proper documentation through biomarkers of exposure and effect supported by comprehensive lab testing that is very specific for mold mycotoxins.
Molds have been present for billions of years and comprise 25 percent of the earth’s biomass. They are everywhere! Most of these molds are harmless and don’t affect our health. But indoor fungi such as aspergillus, penicillium, stachybotrys, cladosporium, and alternaria are capable of creating health issues when at sufficient levels.
Many molds reproduce by making spores. When the spores come into contact with a moist ‘food’ source, they germinate and commence the production of a branching network of cells called hyphae. The hyphae secrete mycotoxins and digestive enzymes that work on cellulose in our house walls. Moisture is a key requirement.
What are some of the health problems mold can cause?
Dr. Vojdani lists seven categories of health affects:
(1) Allergy–immediate reaction
(2) Allergy–delayed reaction, hours to days after exposure
(3) Infection–mainly in susceptible people
(4) Adverse reactions to odor—becoming sensitive to many chemicals
(5) Neurotoxicity—headaches, fatigue, nosebleeds, memory loss
(6) Immunotoxicity—frequent infections, especially of the sinus and lungs; rashes; autoimmune diseases
(7) Mucous membrane irritation
Dr Allan Lieberman, in his paper “Explosion of Mold Cases in Homes, Workplaces and Occupational Medicine Practice,” examined 48 patients who were heavily exposed to mold. The results were as follows:
(1) Muscle and joint pain (71%)
(2) Fatigue and weakness (70%)
(3) Neurocognitive dysfunction (67%)
(4) Sinusitis (65%)
(5) Headache (65%)
(6) Gastrointestinal problems (58%)
(7) Shortness of breath (54%)
(8) Anxiety/depression/irritability (54%)
(9) Chest tightness (42%)
(10) Insomnia (40%)
(11) Dizziness (38%)
(12) Numbness/tingling (35%)
(13) Laryngitis (35%)
(14) Tremors (25%)
(15) Heart palpitations (21%)
In a review paper entitled “Adverse Health Effects of Indoor Molds,” the authors cite the study by Rea et al of 150 heavily indoor mold-exposed patients, which found similar health problems in similar percentages as Lieberman’s study.
The Mayo Clinic noted that 96% of chronic sinusitis patients were infected with fungus. This fact is alarming since antibiotics are repeatedly given to treat the bacteria, but anti-fungals are not given to treat the fungus.
Lebowitz et al reported that 56 percent of 45 patients having sinus surgery had positive fungi cultures.
How should a patient be evaluated for a mold-related symptom?
Environmental sampling can be performed to check for spores and mycotoxins. Placing agar plated mold dishes in suspected moldy environments can yield counts of colony forming units. One study implies more than four colonies could be a problem, especially for those with recurrent sinusitis.
Calling in a mold inspector to do a thorough evaluation and written report of their findings is important. If litigation is involved it is wise to bring in a CIH, Certified Industrial Hygienist, who is qualified by training to determine the presence and extent of mold over growth.
Proper treatment for mold toxicity involves evaluation by an environmental physician, including a comprehensive history and physical examination. Laboratory testing can include:
(1) Mold and mycotoxin antibody levels
(2) Immune markers—T and B cells/natural killer cells
(3) Vision contrast sensitivity
(4) SPECT brain scans
(5) Antimyelin auto-antibodies
Treatment is individualized and specific to the findings of a complete evaluation. Treatment modalities can include: anti-fungal medications, allergy/immunotherapy, treatments for sinusitis, nutritional/herbal support, intravenous vitamin and mineral supplementation, and/or biodetoxification.
Recommendations will be made as to avoidance of the contaminated environment entirely. If that is not an option then proper professional remediation of affected areas is required.
The physicians at COEM have seen thousands of cases of mold exposure and its toxic effects. They are experienced in the accurate diagnosis and treatment of mold injuries and can help you to detoxify your body of mold mycotoxins.
For further information about mold injury:
Please call our office to speak to the New Patient Coordinator, Krystal: (843) 572-1600.
See the article, The Effects of Toxic Molds on Personality and Brain Functioning, by a Licensed Neuropsychologist, for additional information as well.
For information about mold assessment of homes or businesses:
Please see the article in this issue, “Assessment of Mold in Indoor Environments,” by a Certified Indoor Environmental Consultant (CIEC). In addition, mold plates for household sampling of molds are available for our patients at The Center. We can also make referrals for mold inspectors and Certified Industrial Hygienists to assist you in confirming the extent of mold damage in your residence or business.
Curtis L, Lieberman A, Stark M, Rea M, Vetter M. Adverse health effects of indoor molds. Journal of Nutritional and Environmental Medicine (Sept 2004) 14(3) 261-274.
Lieberman, A. Explosion of mold cases in homes, workplaces and occupational medicine practices. Presented at the 21st Annual Symposium on Man and His Environment in Health and Disease, Dallas, Texas, 19-22 June 2003.
Liebowitz, R, Waltzman M, Jacobs J, Pearlman A, Tierro P. Isolation of fungi by standard laboratory methods in patients with chornic rhinosinusitis. Laryngoscope 2002:112(12):2189-91.
Vodjani A, Campbell A, Kashanian A, Vodjani E. Antibodies against molds and mycotoxins following exposure to toxigenic fungi in water-damaged building. Archives of Environmental Health 2003; 58(^):324-36.
Vodjani, A, Thrasher J. Madison M, Gray M, Heuser G, Campbell A. Antibodies to molds and satratoxin individuals in a water-damaged building. Archives of Environmental Health 2003; 58(7)421-32.
Vodjani, A. Health effects and immunotoxicology of toxigenic molds and mycotoxins. Presented at the 21st International Symposium of Man and His Environment in Health and Disease, Dallas, Texas, 20 June 2003.