Shirley Minnoch, Pulmonology

Breathing Easier:
A Cure for Bird Fancier's Disease

Shirley Minnoch recently achieved a milestone in her recovery — a walk around familiar Green Lake on a chilly, but sun-filled Sunday afternoon. "That made me feel so good," said Minnoch, 65, a retired University of Washington Medical Center registered nurse. "It was quite an accomplishment."

Minnoch, a Richland native and world traveller, lives in the Meadowbrook neighborhood. She is recovering from bird fancier's lung disease. While it's not rare, most people have never heard of it. Caused by an allergic reaction to proteins secreted by certain birds, the condition can cause irreparable lung damage unless caught in the early stages. It is progressive and can take months or years to become noticeable. The owner of an African gray parrot for over 30 years, Minnoch had no idea why she was feeling increasingly unwell and short of breath.

Her primary care physician discovered Minnoch's oxygen levels were low and sent her to the emergency room at Northwest Hospital in August 2010. She was admitted to the hospital, where she received a surprising diagnosis from a discerning pulmonologist, Dr. Lynn Keenan.

"The condition is not uncommon," Keenan said. "It's part of our routine as pulmonologists to ask patients about any pets in the home, especially birds." Minnoch confirmed she lived with a female parrot named Peppy.

"Peppy was great company for me," said Minnoch. "She was my late husband's bird and I cared for her for many years — even through a bout of cancer. She was a neat bird. She talked and laughed, and I'd let her fly around the house."

Peppy's particular breed is one of a few known to secrete a fine powder, a protein which helps the animal cleanse itself. Unfortunately, some caretakers experience a severe allergic reaction to the protein.

"Shirley's sisters noticed she had a dry, hacking cough that had been going on for about six months," Dr. Keenan said. "She felt totally out of air. Her oxygen saturation was dangerously low, near 80 percent, and her blood pressure was quite high."

A CT scan revealed lung inflammation. "Some areas looked normal and some were quite abnormal...it was in a mosaic pattern, which is known as 'ground glass aveolitis'," said Dr. Keenan. "I was very suspicious it was bird fancier's lung disease. Her red blood cell count was high because she was not getting enough oxygen."

Before she developed the disease, Minnoch had always enjoyed good health, travelled often, and was trying to shed a few pounds.

"I honestly thought I was out of breath because of my weight," she said. "I had no idea what was really going on. Now that I look back, I believe I was having a gradual reaction."

Dr. Keenan performed a bronchoscopy to rule out any lung infection. Instead, she found evidence of chronic lung inflammation. Minnoch's blood sample was sent to the Mayo Clinic for analysis.

The avian blood hypersensitivity panel showed a strongly positive allergic reaction for parrots," Dr. Keenan said. "I believe Shirley was adjusting to this hypersensitivity, became less active and consequently gained weight. The air sacs, or alveoli, inside her lungs as well as the interstitium, or support, around the alveoli became inflamed and stiff. This made it difficult for her lungs to exchange oxygen."

During her hospitalization, Dr. Keenan also discovered Minnoch had asthma. After stabilizing her on oxygen and various medications, including steroids, her continued recovery depended on two things.

"The bird needed to be removed from the house and the entire house required an industrial cleaning," said Dr. Keenan. "Anything that absorbed the protein had to be removed. Some people can no longer live in their homes and must move."

"My sister, Darlene, didn't think anyone would understand how clean we needed my home to be, so she did it herself," said Minnoch. "She also found a new home for Peppy a home with another African Gray. Peppy said, 'it's okay' when Darlene put her in the cage to take her away. Darlene told me she burst into tears."

A photograph of Peppy remains in Minnoch's hallway, a daily reminder of the beloved pet she had to give up. "I miss her so much," Minnoch says.

Shirley moved in with her sister after her hospital release. Even though she is now on oxygen round the clock, she embraced recovery with courage and confidence. From the beginning, Minnoch has not let the oxygen apparatus limit her activities. She recently returned from a trip to Arizona and likes to explore area beaches. She faithfully works out three times a week as part of her pulmonary rehabilitation at a local therapy center and also walks out of doors as much as she can.

"She is actually healthier now than she was before her illness, which has totally changed her life," said Dr. Keenan. "She took a terrible situation and totally turned it around with exercise, a positive attitude and personal strength and endurance. Shirley does have lung scarring that is not reversible, but she has conditioned her body to become stronger and her asthma is now well controlled. The oxygen is not meant to be an anchor and a chain; it is a means to keep her moving."

Minnoch has lost a total of 60 pounds and her goal is to be off oxygen completely during the day. Keenan said that could possibly be achieved, except when she exercises.

"I had such wonderful care at Northwest Hospital and couldn't have asked for a better doctor," said Minnoch. "She cares so much and encourages me. I would highly recommend her to anybody."

For more information on pulmonology services at Northwest Hospital, visit nwhospital.org/pulmonary.