Defining Chemical Injury-A Diagnostic Protocol and Profile of Chemically Injured

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Defining Chemical Injury-A Diagnostic Protocol and Profile of Chemically

Injured Civilians, Industrial Workers and Gulf War

=========================

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_http://www.iicph.org/docs/ipph_Defining_Chemical_Injury.htm_

(http://www.iicph.org/docs/ipph_Defining_Chemical_Injury.htm)

_IPPH Journal_ (http://www.iicph.org/ipph.htm) / Defining Chemical Injury

Defining Chemical Injury

A Diagnostic Protocol and Profile of Chemically Injured Civilians,

Industrial Workers and Gulf War

by G. Heuser, M.D.,Ph.D. , P. Axelrod and S. Heuser, M.A.

Correspondence to: G. Heuser, M.D., Ph.D. 28240 W. Agoura Road, Suite #203,

Agoura Hills, California 91301, Fax: (818) 865-8814, or P. Axelrod, 2601 N

Street, No. 3, Sacramento, California 95816, (916) 441-4397.

IPPH Volume 13, Fall 2000; Pages 1-16 [iSSN # 8755-5328]

Table of Contents

* _ABOUT THE AUTHORS_ (mip://02737138/default.html#toc0)

* _INTRODUCTION_ (mip://02737138/default.html#toc1)

* _HISTORY_ (mip://02737138/default.html#toc2)

* _PHYSICAL EXAMINATION_ (mip://02737138/default.html#toc3)

* _CENTRAL NERVOUS SYSTEM_ (mip://02737138/default.html#toc4)

* _PERIPHERAL NERVOUS SYSTEM_ (mip://02737138/default.html#toc5)

* _AUTONOMIC NERVOUS SYSTEM_ (mip://02737138/default.html#toc6)

* _EYES_ (mip://02737138/default.html#toc7)

* _NASAL AND PULMONARY PASSAGES_ (mip://02737138/default.html#toc8)

* _GASTROINTESTINAL SYSTEM_ (mip://02737138/default.html#toc9)

* _SKIN_ (mip://02737138/default.html#toc10)

* _IMMUNE FUNCTION_ (mip://02737138/default.html#toc11)

* _ENDOCRINE SYSTEM_ (mip://02737138/default.html#toc12)

* _REGULAR LABORATORY STUDIES_ (mip://02737138/default.html#toc13)

* _TOXICOLOGICAL CONSIDERATIONS_ (mip://02737138/default.html#toc14)

* _CONCLUSIONS_ (mip://02737138/default.html#toc15)

* _SUMMARY_ (mip://02737138/default.html#toc16)

* _ACKNOWLEDGMENTS_ (mip://02737138/default.html#toc17)

* _ABBREVIATIONS_ (mip://02737138/default.html#toc18)

* _REFERENCES_ (mip://02737138/default.html#toc19)

____________________________________

ABOUT THE AUTHORS

Dr. Heuser practices clinical toxicology. He has seen thousands of patients

after toxic chemical exposure and over time developed and used a diagnostic

protocol, which objectively documents chemical injury and impairment.

Heuser has published many peer reviewed articles, contributed book chapters,

and has been internationally recognized in his field. He has been invited to

present his diagnostic protocol in Australia, before the German government

(Bundestag) in Bonn, at the Karolinska Institute in Stockholm (Sweden), and

before the Annual Conference of the National Gulf War Resource Center.

Axelrod directs The Desert Storm Think Tank and Veterans Advocate

which is an ad-hoc association of active duty, reserve and retired soldiers,

scientists, and researchers working together to assess the impacts and

consequences of war in general with a specific emphasis on The Persian Gulf War.

Axelrod's work has assisted in American, German and United Kingdom governmental

investigation and reform. Her work has received a Project Censored Award from

the Sonoma State University, Sonoma, California. She is also the recipient of

a 1990-91 D. and T. MacArthur Foundation Research and Writing

Grant,which helped seed The Desert Storm Think Tank. Her 1993 ground

breaking article, «Research Guide for Desert Storm Syndrome (International

Perspectives in Public Health Vol. 10, 1994) has been entered into the records

of a

number of U.S. funded committees for the investigation of Persian Gulf War

illness, including those conducted by Senator Reigle, the National

Institutes of Health, and the Presidential Advisory and Oversight Committees.

In

preparation for this article Axelrod traveled to and from post-war Baghdad, I

raq. In addition she has interviewed and debriefed hundreds of Persian Gulf

Veterans.

Both Heuser and Axelrod are founding members of the State of California,

Reserve Officer Association committee on Persian Gulf War Illness.

Sylvia Heuser is president of EMRIC (Environmental Medical Research and

Information Center) which is based in Dr. Heuser's office and supports all his

research and writing projects with ideas, literature search, and review of

patient files.

INTRODUCTION

Chemical injury can cause severe, often disabling multi-system complaints,

which may persist for months and at times years after chemical exposure has

ceased. Physicians who see chemically injured patients are frequently baffled

when they face a patient with multiple complaints, which do not fit into a

known diagnostic disease category. Furthermore, regular laboratory tests (e.g.

CBC, liver function tests, sedimentation rate, urinalysis) are often normal as

is a cursory physical examination.

The diagnostic exploration of a chemically injured patient is a new field,

which is difficult for the inexperienced physician. Chemically injured patients

often complain of impaired cognitive and memory functions, intermittent

confusion and disorientation, changes in behavior and mood, word-finding

problems, sleep disorders, decreased libido and potency. At times they complain

of

seizure-like events. They also often report recurrent flu-like symptoms,

fatigue and exhaustion, malaise, headaches, and chronic pain. Skin rashes,

gastrointestinal complaints, and other health effects may also be present.

Different

patients may react differently to a given chemical or group of chemicals.

Toxic effects cannot be objectively evaluated unless every involved system is

studied with advanced and sophisticated methodology. Without benefit of that

process, a chemically injured patient will be dismissed with a diagnosis of

post- traumatic stress disorder, somatization disorder or other labels

implying that «it's all in their heads» [off, et al., 2000]. The largest

patient population to have received such a diagnosis is that of the Persian

Gulf

War Veterans. As of the writing of this article, nine years after the armed

conflict, several hundred thousand veterans still suffer from a host of

symptoms called «Persian Gulf War Illness» which may in large part be due to

chemical injury [Jamal, 1998; Everson et al., 1999].

The authors understand that war time in Iraq exposed people not only to

chemicals but also to uranium 238, a.k.a. depleted uranium, electromagnetic

radiation, experimental vaccines, pyridostigmine bromide, biological warfare

agents, and diseases and parasites indigenous to the Middle East e.g.

leishmaniasis and brucellosis. Any of these toxins and infectious agents,

individually or

in combination, may carry with it a host of health effects. The purpose of

this paper is not to dismiss those impacts but rather to offer currently

available diagnostic techniques which, if applied correctly, will help both

patient and physician assess how a toxic environment alone may contribute to

illness otherwise dismissed as psychosomatic.

In this paper we will guide the reader through a diagnostic protocol which

the senior author has developed and used on thousands of his chemically injured

patients. We propose tests and consultations (from experts in their

respective fields) which from our experience and research are most helpful in

documenting and at times quantifying the effects of toxic chemical exposure.

In discussing our approach, we will take one organ system at a time, discuss

and select diagnostic tools and tests appropriate to the evaluation of a

given system. Single abnormalities in a single system can have many causes.

Abnormalities in multiple systems can also have many etiologies. However, a

careful differential diagnosis (using this suggested protocol) will arrive at a

tenable diagnostic impression of chemical injury if multiple objective

abnormalities are found and cannot be explained on any other basis. Thus, a

diagnosis

of chemical injury is arrived at in part by exclusion of other diseases,

which may have predated the toxic exposure in question.

In the experience of the authors there is no doubt that chemical exposure

(solvents, pesticides, chemical weapons, others) occurred during the Gulf War.

In this sense, Gulf War Veterans deserve the same careful evaluation which is

indicated in patients who have been exposed to chemicals at home, at work, or

elsewhere (e.g. commuting) here in the USA.

The protocol begins with an exhaustive case history, to be followed by a

careful physical examination, laboratory tests, and specialty consultations.

Patient and doctor should seek out consultants who display interest rather than

indifference. Generally an enthusiastic, curious and interested consultant

specialist will be a better member of the evaluation team and bring his or her

methodology to bear when tackling the problem of diagnosing chemical injury.

The evaluation process ends with case definition and a better understanding of

the patient's problems and needs. Most importantly, this process will lay

the foundation for rational and compassionate treatment.

This paper does not address the experienced clinical toxicologist. Rather, it

is meant to help the personal physician to follow a road map of

investigation when facing a patient who presents with a history of chemical

injury.

This paper is also meant to help the educated layperson who has been

chemically injured and is being told that nothing is wrong since nothing

abnormal

can be found (on minimal testing only!).

In our experience, both the general physician and the educated patient need a

guide to follow when trying to understand and evaluate a toxic situation.

This paper is meant to function as such a guide.

The need for a road map is especially urgent since society is pressured by

some of its segments to attach a psychiatric diagnosis to some patients and to

then hospitalize them with that diagnosis.

Go to this link for complete paper

_http://www.iicph.org/docs/ipph_Defining_Chemical_Injury.htm_

(http://www.iicph.org/docs/ipph_Defining_Chemical_Injury.htm)

B.Olinsky, M.S.

Environmental Specialist