Case Studies

The Little Girl and Her Couch

© 2017 Jeffrey C. May

A concerned father called me because his four-year old daughter was suffering from chronic asthma. He described his disappointment at being unable to alleviate her symptoms, despite all the heroic efforts the family had put into changing their lifestyle. They had torn out wall-to-wall carpeting and installed hardwood floors, replaced the playroom couch with a leather one, put allergen mattress and pillow covers on their daughter’s bed, and taken away all of her favorite dolls and stuffed animals from her bedroom. They washed her bedding every week and kept the whole house immaculate.

The strangest part of all of this was that whenever they stayed in their summer cabin, which was carpeted wall-to-wall and was dusty, their daughter was fine. As soon as they returned home, she began to have problems with her asthma.

The little girl hadn’t slept through the night at home for years. Twice a night, the parents took turns placing their daughter on a nebulizer, to administer inhaled medication in order to ease her breathing problems.

As I drove down the street to the home, I was struck by the diversity in the styles of the houses on the street. Each home was different from the next, and snow and ice covered the street and walkways. The family’s house was a well-maintained single family with a steep gable roof. The ground was frozen, and there had been a recent, heavy snow. When I parked the car, the father came out to greet me to be sure I didn’t slip on the icy driveway. I was struck by his quiet kindness, and from the moment I met him, I could feel his concern over his daughter and his frustration at not being able to do anything to improve the situation.

What worried me when I entered the house was that the space was so clean and well-maintained that I wouldn’t find any potential indoor sources of allergens and so wouldn’t be able to help the family. Luckily, I was wrong.

The father led me to the basement and then through every room in the house, explaining how they had cleaned things and the items they had replaced. I could see with a mirror and flashlight, though, that the only areas in the house that hadn’t been cleaned of all dust were the bottoms of the heat convectors in the walls.

When he was through, I began collecting my air and dust samples. The couch in the playroom was the new leather one, but the couch and the easy chairs in the living room, where his daughter also played, were older. I took samples of the dust from these older pieces of furniture and found that they were infested with dust mites. One of them also contained some mold and bacteria.

Back at my lab, as soon as I examined the slides, I called the father and suggested that they remove all the dust from all the convectors (using a HEPA vacuum) and replace the living room furniture. In the meantime, I recommended that they cover the couch and easy chairs with plastic, to seal in the allergens. Later, I found out that as soon as we hung up, he went out and bought heavy plastic drop clothes and duct tape to accomplish the “re-upholstering.” He carefully wrapped each piece of contaminated furniture in plastic and sealed the seams as if he were wrapping a gift. The next day, they cleaned the convectors as instructed.

Even though they continued to use the somewhat uncomfortable furniture, the daughter began to sleep through the night. He reported to me that within days, she was off the nebulizer, and her symptoms had been reduced by 80%.

This story proved to me once again, that despite our best efforts, one or two omissions in our war against an unseen enemy can still leave us vulnerable.

Woman with the Chronic Cough

Images and Text © 2017 Jeffrey C. May

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This is a light photomicrograph (about 400x) of dust from Sally’s living-room easy chair. The long pink rectangular shapes are dog dander, and the brown spherical shapes are dust mite fecal pellets.

When I first met them, Sally and Burt had been married for 50 years. Though they taunted and teased each other mercilessly while I was in their home, it was clear to me that they cared for each other deeply and were almost the same person – they even finished each other’s sentences.

Sally and Burt had lived in the same house since their wedding day. When their oldest daughter got married, they changed the home into a two-family and moved to the first floor, converting a porch built over a crawl space at the back of the house into their new bedroom. Their daughter and her husband lived in the larger apartment above, and over the years, two grandchildren joined the extended family.

Their grandson has asthma. His parents had just stopped smoking because they felt that this would help their child, but the wall to wall carpet in the upstairs apartment still reeked of smoke. Because she had a chronic cough condition, Sally hadn’t slept through the night in three years. She would awaken and have to sit up, because she coughed so violently. Then she would pace for hours to calm down enough to go back to sleep. Sally and Burt had a small dog that I suspected might be a problem, and when I visited the house, they put the pooch in a cage for the duration of my stay.

When I arrived, we sat in the kitchen while Burt described his wife’s health problems. Sally was sitting in the background, adding comments and muffled coughs. As per my instructions, they had shut all the doors to the various rooms before my visit, to keep air flows to a minimum. The master bedroom was located off the kitchen, and when I opened the door and peeked in, I immediately started to cough (I’m allergic to mold and dust mites).

I explained to the couple that I would have to wear a fine particle mask in order to enter their bedroom to take dust and air samples. As I was putting on my mask, it occurred to me to offer one to Sally. I went out to my car to get a new mask for her, and showed her how to wear it properly (taking care to be certain the fit around her nose was airtight). She looked uncomfortable sitting there with a mask on her face, but I noticed immediately that she was a lot quieter; she had stopped coughing. For the entire three hours of my visit, I don’t think that Sally twitched, for fear that she would start to cough again. When I was packing up my equipment to leave, I suggested that she and I both remove our masks together. We both started coughing at the same time.

Subsequent analysis of the air and dust samples revealed significant contamination of the bedroom carpet with dust mites and mold. The presence of carpeting in their bedroom was particularly problematic, for the room wasn’t adequately heated; the floor, three of the walls, and the ceiling (directly under a low roof) were always cold. This led to high relative humidity in the cooler seasons of the year. Mildew grows on surfaces when the relative humidity is high; in fact, during my visit, I had seen mildew on the wood panel at the back of their bedroom dresser.

I suggested that Sally spend that night in the guest room, where there was a hardwood floor and a pullout couch that was rarely used. She slept through the night for the first time in years. I recommended that they remove the carpeting in their bedroom and install hardwood floors, disinfect the bedroom walls with a mild bleach solution, and keep the room warmer. I also strongly encouraged them to pick another room for their bedroom.

They later followed my recommendations, and most of Sally’s coughing problems disappeared.

Sally is a remarkable person – a real fighter. She had had at least two different surgeries for medical problems, and a third procedure to correct a hernia that resulted from a severe coughing fit. Her spunk was admirable, but some of her suffering, at least from the coughing and hernia, could have been avoided.

The House Built Over a Crawl Space

© 2017 Jeffrey C. May

Sam and Laura were worried that their house was contaminated with mold, because it was built in a wetland. Recent allergy testing had revealed that Laura was allergic to mites and mold, and Sam to pollen. They had a two year old son, and they wanted to be sure that their house was as allergen-free as possible, not only for their own comfort, but in case he, too, developed sensitivities.

When we spoke on the phone prior to my visit, they talked about a high water table on their property. I didn’t realize exactly how high until I approached their house and had to avoid the pond on either side of the causeway they called the driveway to their property. Geese wandered freely as they waddled from one pond to another, and when I stepped out of the car, I saw a muskrat disappear in a swirl at the pond’s edge, inches from my feet. I immediately realized why all the houses in their neighborhood had been built on crawl spaces rather than full foundations with basements. Had there been basements, they would have been not wet, but flooded on a pretty permanent basis.

Sam and Laura had already done a lot to make their home allergen free. They had removed all the wall-to-wall carpeting and installed hardwood floors. They had replaced wool area rugs with synthetic. Their mattresses and pillows were encased in mite-covers, and they had had the ducts in their hot air/central air conditioning system cleaned twice. Since in my experience fragrances and fabric softeners can also be a problem for some people, I also recommended that the family stop burning fragranced candles and cease using fragranced laundry detergent and dryer sheets with softeners.

There were other steps to take, however, as a result of poor control of roof water on the outside of their home. Their gutters were clogged, and there was improper grading around the foundation. Consequently, water was pooling along the edges of the floor of their cement crawl space. In one of these puddles sat moldy carpet and wood scraps. The smell of mold permeated the ductwork and drifted up into the house through the heat registers. I recommended that they improve the drainage and maintain their gutters. I suggested that they hire a professional to remove the debris from the crawl space and clean the area.

This work would take some time and involve hiring other people, and would certainly remove the smell of mold from the inside of the house. The most serious problem in the house, though, was easier to fix. Sam had an old desk chair in his home office that had belonged to Laura before they were married. It was about 15 years old, and the fabric thin and worn from frequent use. Laura told us that Sam loved that chair, and on weekends, he sometimes spent four or five hours sitting in it as he did deskwork at home.

The chair was infested with dust mites. They got rid of the chair and bought a leather one instead: probably one of the best investments they made to improve the air quality in their house!