Environmental Medicine
Years ago I heard Doris Rapp, M.D. begin an American Academy of Environmental Medicine conference with the statement:
When I came into pediatric allergy years and years ago, I never dreamed that it would lead to anything as magnificent as Environmental Medicine. This is a whole new wonderful phase of medicine, and it is sort of like putting a mouse in a cheese factory--we never had it so good. For the first time in our lives the physician can actually pinpoint that your headache is due to milk, that over activity or inability to write is due to something you've just smelled, that dust or mold is causing your legs to become weak, or causing you to act inappropriately. It is absolutely magnificent and I cannot understand why everybody isn't beating a path to our door.
In the preface of his four-volume textbook, Chemical Sensitivity, which reports the results of the study of more than 20,000 environmentally sensitive patients seen at the Environmental Health Center-Dallas, William J. Rea, M.D. stated:
No longer is symptom suppression and/or intervention after the onset of end-organ damage the focus of healing. Instead, our approach emphasizes the importance of isolating and eradicating root causes of illness before fixed-named disease and permanent damage can occur.
Our study of chemically sensitive individuals has convinced us that after exposure to certain sets of environmental pollution many people experience a lowered resistance to illness that is followed by periods of vulnerability during which their susceptibility to illness increases. We believe that this is the time when intervention is critical. If, under controlled conditions, these pollutants can be identified along with their route of entry and their effect on individual systems, both intervention and prevention programs can be implemented to combat the threat of chronic illness with multiple symptom manifestation that could lead to fixed-named disease and permanent organ damage.
Attention to the principles (total body load, adaption, bipolarity, bio-chemical individuality, spreading, and switch phenomenon) that we have developed along with implementation of our method of exposure and challenge followed by diagnosis and treatment has many advantages. Through the identification of causative factors (triggering agents), their elimination or reduction, and the education of patients as to the resourcefulness of good nutrition and the effects of environmental pollutants upon it, physicians can help their patients gain relief from much unnecessary suffering. Patients can achieve improved health, and they can exert control over their life through their own active management of their illness. They can expect a marked decrease in their health care expenses as their chronic symptoms dissipate and end-organ damage or fixed-named disease is avoided.
Now, again, why isn't everyone beating a path to the door of Environmental Medicine? The following is a description of Environmental Medicine taken from the American Academy of Environmental Medicine web site, www.aaemonline.org, by permission:
What Is Environmental Medicine?
Simply stated, Environmental Medicine is concerned with the interaction between mankind and the environment. More specifically, Environmental Medicine involves the adverse reactions experienced by an individual on exposure to an environmental excitant. Excitants to which individual susceptibility exists are found in air, food, water, and drugs, and are frequently found in the home, work, school, and play environments. Exposures to these agents may adversely affect one or more organ systems and this effect is commonly not recognized by individuals and their physicians.
Environmental Medicine offers a sweeping reinterpretation of medical thinking, especially in its approach to many previously unexplained and ineffectively treated chronic diseases. The basis of this view is the simple concept that there are causes for all illnesses, and the obvious but not well accepted fact, that what we eat or are exposed to in our environment, has a direct effect upon our health.
The basic theories of Environmental Medicine include the "total load" concept, individual susceptibility, and adaptation. The "total load" concept postulates that multiple and chronic environmental exposures in a susceptible individual contribute to a breakdown of that person's homeostatic mechanisms. Rarely is there only one offending agent responsible for causing a diseased condition. Multiple factors co-exist, usually over a prolonged period of time in bringing about the disease process. Individual susceptibility to environmental agents occurs for a variety of reasons including genetic predisposition, gender, nutritional status, level of exposures to offending susbstances, infectious processes, and emotional and physical stress. Adaptation is defined as the ability of an organism to adjust to gradually changing sustained circumstances of its existence. Maladaption would be a breakdown of the adaptive mechanism.
(The American Academy of Environmental Medicine hosts an Annual Meeting and Conference every fall and Instructional Courses in the spring. The AAEM was founded in 1965. Environmental Medicine physicians can be located on the AAEM web site www.aaemonline.org or by contacting the main office: AAEM, 6505 E. Central, Suite 296, Wichita, KS 67206, 316-684-5500.)
MCS: A 1999 Consensus
According to "Multiple Chemical Sensitivity: A 1999 Consensus" signed by 34 physicians and researchers, "There is a significant need for a standardized clinical definition of MCS and a comprehensive clinical protocol that VA, DOD, and other physicians can use to evaluate it." Here is the Abstract from the 1999 Consensus paper:
Abstract
Consensus criteria for the definition of Multiple Chemical Sensitivity (MCS) were first identified in a 1989 multidisciplinary survey of 89 clinicians and researchers with extensive experience in, but widely differing views of, MCS. A decade later, their top 5 consensus criteria (i.e., defining MCS as
[1] a chronic condition
[2] with symptoms that recur reproducibly
[3] in response to low levels of exposure
[4] to multiple unrelated chemicals and
[5] improve or resolve when incitants are removed)
are still unrefuted in published literature. Along with a 6th criterion that we now propose adding (i.e., requiring that symptoms occur in multiple organ systems), these criteria are all commonly encompassed by research definitions of MCS. Nonetheless, their standardized use in clinical settings is still lacking, long overdue, and greatly needed - especially in light of government studies in the United States, United Kingdom, and Canada that revealed 2-4 times as many cases of chemical sensitivity among Gulf War veterans than undeployed controls. In addition, state health department surveys of civilians in New Mexico and California showed that 2-6%, respectively, already had been diagnosed with MCS and that 16% of the civilians reported an "unusual sensitivity" to common everyday chemicals. Given this high prevalence, as well as the 1994 consensus of the American Lung Association, American Medical Association, U.S. Environmental Protection Agency, and the U.S. Consumer Product Safety Commission that "complaints [of MCS] should not be dismissed as psychogenic, and a thorough workup is essential," we recommend that MCS be formally diagnosed - in addition to any other disorders that may be present - in all cases in which the 6 aforementioned consensus criteria are met and no single other organic disorder (e.g., mastocytosis) can account for all the signs and symptoms associated with chemical exposure. The millions of civilians and tens of thousands of Gulf War veterans who suffer from chemical sensitivity should not be kept waiting any longer for a standardized diagnosis while medical research continues to investigate the etiology of their signs and symptoms.
Correct Diagnosis and Treatment Make a Big Difference
In the Introduction to Dr. Rea's four-volume book, Chemical Sensitivity, he presents a representative case of unknown chemical sensitivity. This example shows what a difference the true diagnosis and treatment can make to a person's health:
Case Study - A 35-year old white female was in perfect health for the first 30 years of her life. She then developed recurrent sinusitis with odor sensitivity that was treated with symptom-suppressing medication. She did well for 2 years when she developed severe premenstrual tension with recurrent headaches, which were treated with symptom suppressing medication. She again did well for about 2 years until she developed back and leg pain caused by lumbar disc disease which required surgery. Postoperatively, she developed thrombophlebitis which responded to anticoagulants. After 6 months, this patient developed symptoms of anxiety, shakiness, weakness, and an inability to sleep. Her premenstrual tension increased including severe abdominal cramps. She was treated with tranquilizers but eventually became medication sensitive and developed phlebitis, which was refractory to medication. She became incapacitated, unable to walk, and developed a pulmonary embolus.
When, after 5 years from the onset of her initial symptoms, this patient had failed to regain her health through the usual course of treatment, she sought help at the EHC-Dallas where a new method of intervention was utilized. First, a careful environmental history was taken. It revealed that she had been working in an old clothing store when her sinusitis and odor sensitivity developed. This patient had noticed that when a severe rain would leak into the store followed by mold odor, she would have a stuffed up nose. She had also noticed that when boxes of new clothes were unpacked her nose would burn and run. She had related these facts to several physicians who, unaware of their significance, had dismissed them.
This patient next underwent challenge testing. She reacted with a severe stuffed up nose and sinus pain to intradermal challenge with mold extracts. Both intradermal and inhaled challenges of ambient doses of formaldehyde (<0.2 ppm) caused severe odor sensitivity, runny and burning nose, and sinus pain. Intradermal challenge of estrogen, an oral ingestion of milk, and an inhaled challenge of phenol (<0.002 ppm) reproduced her premenstrual tension and headaches. Oral and intradermal challenge of estrogen and intradermal and inhaled challenge of formaldehyde and phenol provoked her thrombophlebitis. After blood analysis showed deficiencies in vitamin C, magnesium, manganese, and molybdenum, supplementation of these nutrients eliminated her postdiscectomy pain. After both a 24 h urine analysis and an intravenous challenge of 25 meq of magnesium revealed a magnesium deficiency, supplementation of this mineral eliminated her premenstrual cramps, anxiety attacks, weakness, and inability to function.
This patient was diagnosed with environmentally triggered disease. As part of her treatment, she constructed an environmentally controlled oasis at home, where as many triggering agents as possible were removed. She has been active and vigorous for the past 15 years without the onset of new symptoms, the recurrence of old ones, or the need of medication.
This case illustrates an evolving health concept that acknowledges a causative link between environmental exposures to multiple toxic and nontoxic agents, the eventual onset of chemical sensitivity, and the eventual development of named, clinical disease. This concept is based on four essential tenets.
First, even in the presence of individual and nutritional variations, the development of chemical sensitivity is dependent on the relationship of the individual to his environment.
Second, exposure to deleterious environmental factors if ignored and allowed to continue has potentially harmful effects.
Third, a significant time span may exist between an initial toxic environmental exposure or repeated exposures and the development of chemical sensitivity which may lead to a specific fixed-named disease. It is critical to note that even after the onset of a named entity, chemical exposures may remain the prime factor in propagating this disease.
Finally, from the onset of a toxic exposure to the development of end-stage clinical disease, there is a spectrum of multiple signs and symptoms which represent the biological markers of the effect of the exposure. They must be recognized and eliminated early if end-stage disease is to be prevented. Then for the chemically sensitive to achieve and maintain optimum health, their total load must be reduced, and they must remain deadapted in the alarm stage. In this state, their immune and enzyme detoxification systems respond more appropriately to pollutant insults in a finite manner. Their range of physiological adaptation then expands, and they can maintain symptom-free, optimum health even when they experience an isolated high-level pollutant exposure.
And, once again, as Dr. Doris Rapp described Environmental Medicine as "absolutely magnificent," we cannot help but wonder with her "Why everybody isn't beating a path to our door?"
(The four-volume textbook Chemical Sensitivity by Dr. Rea can be purchased from the American Environmental Health Foundation, 8345 Walnut Hill Lane, Suite 225, Dallas, TX 75231, 800-428-2343. The Foundation hosts a symposium each June, "Man in His Environment." The Foundation also sells many non-toxic products.)
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