DR.G. ZIEM'S ENVIRONMENTAL CONTROL PLAN FOR CHEMICALLY SENSITIVE PATIENTS

[Guest guest]

DR. GRACE ZIEM'S

ENVIRONMENTAL CONTROL PLAN

FOR CHEMICALLY SENSITIVE PATIENTS

16926 Eyler's Valley Road, Emmitsburg MD 21727, 301-241-4346

_http://www.mcsrr.org/resources/articles/S3.html#exercise_

(http://www.mcsrr.org/resources/articles/S3.html#exercise)

TABLE OF CONTENTS

 

1. _REQUIRED READING_

(http://www.mcsrr.org/resources/articles/S3.html#readings)

2. _PESTICIDE USE WARNING_

(http://www.mcsrr.org/resources/articles/S3.html#pesticides)

3. _REMODELING WARNING_

(http://www.mcsrr.org/resources/articles/S3.html#remodel)

4. _DIETING WARNING_

(http://www.mcsrr.org/resources/articles/S3.html#dieting)

5. _ILLNESS LOG_ (http://www.mcsrr.org/resources/articles/S3.html#log)

6. _MEASURING EXPOSURE LEVELS_

(http://www.mcsrr.org/resources/articles/S3.html#measuring)

7. _CONTROLLING EXPOSURES IN YOUR WORKPLACE_

(http://www.mcsrr.org/resources/articles/S3.html#work)

8. _CONTROLLING EXPOSURES IN YOUR SCHOOL_

(http://www.mcsrr.org/resources/articles/S3.html#school)

9. _CONTROLLING EXPOSURES IN YOUR BEDROOM_

(http://www.mcsrr.org/resources/articles/S3.html#bedroom)

10. _CONTROLLING OTHER EXPOSURES IN YOUR HOME_

(http://www.mcsrr.org/resources/articles/S3.html#home)

11. _CONTROLLING AIR QUALITY_ (http://

www.mcsrr.org/resources/articles/S3.html#air)

12. _CONTROLLING WATER QUALITY_

(http://www.mcsrr.org/resources/articles/S3.html#water)

13. _USING EXERCISE AND SAUNA TO ELIMINATE TOXINS FROM YOUR BODY_

(http://www.mcsrr.org/resources/articles/S3.html#exercise)

14. _CONTROLLING EXPOSURES IN FOOD_

(http://www.mcsrr.org/resources/articles/S3.html#food)

15. _CONTROLLING EXPOSURES IN YOUR MEDICAL CARE AND MEDICATIONS_

(http://www.mcsrr.org/resources/articles/S3.html#medical)

16. _CONTROLLING NEIGHBORHOOD PESTICIDE EXPOSURE_

(http://www.mcsrr.org/resources/articles/S3.html#neighborhood)

17. _IF YOU NEED TO MOVE TO ANOTHER DWELLING_

(http://www.mcsrr.org/resources/articles/S3.html#move)

18. _PSYCHOLOGICAL COUNSELING_

(http://www.mcsrr.org/resources/articles/S3.html#counseling)

19. _SEX AND MCS_ (http://www.mcsrr.org/resources/articles/S3.html#sex)

20. _OXYGEN USE DURING REACTIONS_

(http://www.mcsrr.org/resources/articles/S3.html#oxygen)

21. _NUTRITION_ (http://www.mcsrr.org/resources/articles/S3.html#nutrition)

22. _LEGAL ISSUES_ (http://www.mcsrr.org/resources/articles/S3.html#legal)

23. _MISCELLANEOUS_ (http://www.mcsrr.org/resources/articles/S3.html#misc)

24. _GETTING MORE INFORMATION_

(http://www.mcsrr.org/resources/articles/S3.html#info)

25. _REFERENCES_ (http://www.mcsrr.org/resources/articles/S3.html#references)

 

1. Required Reading

 

Read through the article that Dr. Ziem wrote for her patients entitled

" Multiple Chemical Sensitivity: Treatment and Follow-up with Avoidance and

Control

of Chemical Exposures, " and then read through it again. (The article is

included in your patient packet and also can be ordered separately from Dr.

Ziem's office). The first time, be thinking about the general approach needed

to

improve your health. The second time, look at specifics and make notes of

things you will need to do to make your environment safer and to reduce your

body

burden of toxic chemicals.

 

Also read through the book Less Toxic Living by Carolyn Gorman, which Dr.

Ziem will give you when you come for your first visit (or you can order it from

her office by mail). Carolyn Gorman is a health educator who has counseled

thousands of chemically sensitive patients and this book reflects her

experience and that of many patients regarding what things make such persons

sick. In

each category of product, think about the products you may have around the

house which are unsafe. Any products which contain toxic chemicals described

as things to avoid in this book should be removed from the house and garage

whenever possible. (Toxic chemicals stored in your garage may release vapors

that can attach to fabric and other surfaces of your car.) Replacing toxic

products is much less expensive than being treated for the illness and chronic

fatigue that often accompany ongoing exposures.

 

Other references which help you make a healthier environment include the

books Success in the Clean Bedroom by Natalie Golis and Common Sense Pest

Control by Olkowski. UNTIL YOU KNOW MORE ABOUT WHAT PRODUCTS TO AVOID, do not

purchase any potentially toxic consumer products without first checking in Less

Toxic Living (or with other chemically sensitive persons) for recommended

alternatives.

2. Pesticide use warning

 

DO NOT USE OR ALLOW THE USE OF ANY PETROCHEMICAL PESTICIDE IN YOUR HOME OR

WORKPLACE. Most commercially available pesticides contain petrochemicals and

substances which are toxic to the brain and nervous system. They can cause

severe effects in chemically sensitive patients. YOU CANNOT AVOID PESTICIDE

ILLNESS BY SIMPLY LEAVING THE ROOM AND AIRING OUT THE SPRAYED AREA. Most

pesticide spraying applications leave a toxic residue that remains for weeks or

months, gradually giving off toxic chemicals into your home or work

environment.

3. Remodeling warning

 

DO NOT DO ANY REMODELING IN YOUR HOME WITHOUT FIRST DISCUSSING THE PROJECT

WITH DR. ZIEM OR SPECIALISTS IN NON-TOXIC BUILDING AND CONSTRUCTION MATERIALS,

SUCH AS JIM NIGRA (818-889-6877) OR MARY OESTEL (512-288-2369). If you

notice any remodeling, construction or repair being done in your workplace, it

is

URGENT that you consult one of the above experts immediately, to avoid a

severe increase in your illness.

4. Dieting Warning

 

Petrochemicals are stored in body fat. When the fat is " broken down " with

dieting (it enters the blood before being " burned " as energy), the chemicals

stored there also enter the blood. Chemically sensitive patients often have

increased symptoms with dieting. If you are overweight and need to diet, you

should do so in conjunction with exercise and sauna therapy (see below), to

help

you excrete these chemicals. Do NOT try to achieve rapid weight loss (no

more than one pound per week) and avoid " diet pills. " (It is better to avoid

sugars and eat more fiber-containing foods.) If your symptoms are still

significant, contact Dr. Ziem to discuss the risks and benefits of dieting to

your

health. Unless you are overly thin, YOU SHOULD TRY TO AVOID GAINING MORE

WEIGHT. Regular exercise (like daily walking in a non-toxic park) can help with

weight control.

5. Illness Log

 

Please keep a written record of your illness reactions, with entries in 3

separate columns as shown in the example below: Date Symptoms Exposures

(Prior 6 Hours) 1/15/94 Headache, Nausea, Confusion Pumped Gas, 2 Hours In

Traffic

A sample log sheet is included in your patient packet. Keeping the

information this way will make it easier for Dr. Ziem to review your exposures

(to see

what things in your environment still need attention) and your symptoms (to

see what types of medical problems you have been having).

 

Under date, record the date you noticed a worsening of your symptoms. Under

symptoms, list the changes you noticed in your mind or body, such as

headache, sore nose, cough, chest tightness, or whatever other effects you

noticed.

If you have too many symptoms to record them all, record the main ones and any

new ones and put " etc. " so Dr. Ziem will know you had other unlisted

symptoms. Under the exposure column, list any exposures you had in the 6 hours

before you first noticed symptoms or started feeling worse. List the location

where you were in those 6 hours before you felt worse, such as at work, in a

hardware store, in traffic. If there were several locations, list them. Bring

your log to each appointment with Dr. Ziem and give it to her to review.

6. Measuring Exposure Levels

 

Measuring exposure levels in the home or workplace is expensive and not

usually very helpful in controlling chemical sensitivity since we don't know at

this time what levels of exposure cause reactions or what ongoing levels of

exposure might make them worse (there may be no safe detectable level in some

cases). However, if you need to document whether a chemical exposure has

occurred, Dr. Robert Olcerst (410-566-0859), a toxicologist and industrial

hygienist, may be able to help you. Please contact Dr. Ziem first to be sure

the

information cannot be obtained in a less expensive way. Dr. Olcerst should not

make decisions on environmental controls for you unless discussed with Dr.

Ziem.

 

The " threshold limit value " exposure limits used to regulate exposure to

toxic chemicals (also called TLVs) were never designed to protect sensitive

workers. The " TLV booklet " states that " Individuals may also be

hypersusceptible

.... because of ... previous exposures. Such workers may not be adequately

protected from adverse effects ... at or below the threshold limit " _[1_

(http://www.mcsrr.org/resources/articles/S3.html#1) , see _Reference section_

(http://www.mcsrr.org/resources/articles/S3.html#references) at the end of this

paper]. The TLV exposure limits used by industrial hygienists were adopted as

legal standards before it was known that there were serious scientific and

other

problems in the development of the TLVs. Health effects below the TLVs are

commonly reported in the medical literature _[2]_

(http://www.mcsrr.org/resources/articles/S3.html#2) . Research into the TLVs has

documented serious

problems with corporate influence during their development which was not known

to

the public _[3]_ (http://www.mcsrr.org/resources/articles/S3.html#3) . In

addition, comprehensive literature searches were not done for the development

of

the vast majority of the TLVs _[3]_

(http://www.mcsrr.org/resources/articles/S3.html#3) . Finally, the TLVs have

been shown to demonstrate no statistical

correlation with the exposure levels reported to cause illness in the

literature that was used by the TLV Committee _[4]_

(http://www.mcsrr.org/resources/articles/S3.html#4) . They do, however, bear a

strong correlation with existing

exposure levels in industry at the time _[4]_

(http://www.mcsrr.org/resources/articles/S3.html#4) . Many TLVs were apparently

based largely on economic

rather than health considerations _[4]_

(http://www.mcsrr.org/resources/articles/S3.html#4) . Indoor air quality

standards have been largely derived from

these TLVs, and thus these standards suffer from the same scientific

inadequacies as the TLVs themselves _[5]_

(http://www.mcsrr.org/resources/articles/S3.html#5) .

7. Controlling Exposures In Your Workplace

 

The Americans With Disabilities Act (ADA) requires that employers and others

make reasonable accommodations for persons with handicaps. If your chemical

sensitivity interferes significantly with your ability to work, attend

school, do errands, or do housework, you have a handicap as defined under this

law.

Reasonable accommodation for someone needing a wheelchair includes a

specially designed stall in the rest room, special water fountains at a height

the

person can reach, etc. Reasonable accommodation for a chemically sensitive

person can include special filtering devices designed for chemically sensitive

persons, a no-smoking policy, a special parking area away from fumes,

non-toxic pest control, non-toxic cleaning products, non-toxic construction

products,

the elimination of " air fresheners " (which are petrochemicals and toxic),

and other environmental controls.

 

Dr. Ziem will ask you about your workplace and potential exposures and

develop a plan for reasonable accommodation for your workplace. If you have

workplace exposures you think are a problem or if you notice that you feel more

sick after work than at the end of a weekend or holiday, you could have

workplace exposures that need to be better controlled. Make notes about your

health

(use your illness log) and anything about the workplace you want to discuss

with Dr. Ziem and call her for an appointment. Don't just " tough it out " with a

problem workplace: Dr. Ziem has more than a few patients who did this and

all went on to develop more serious and longer lasting health problems. Never

sacrifice your health because you don't want to " make waves " or " cause

trouble, " even a few days of problem exposure can cause increased disability

for

many weeks or months, and a few weeks of toxic exposure can cause problems for

many months or even years. If you are asked or required to resume working (or

living) in a building which may be affecting your health, it is important

that you be examined by Dr. Ziem shortly before you return on a regular basis

and again, one to three months after you've returned. By comparing the results

of your physical exams and laboratory tests, Dr. Ziem will be able to

document whether your return has had any impact on your health and whether

accommodation measures are adequate.

 

The ADA is civil rights legislation that forbids discrimination against the

handicapped just as we have legislation forbidding discrimination against

women and racial minorities. It is enforced by the Justice Department of the

United States Government and penalties can be stiff. If your employer has been

notified of your condition and refuses to make reasonable accommodation or

harasses you in any way (illegal under this law), contact Dr. Ziem immediately.

Keep written notes of any conversations with your employer or employer

representatives and any problems you have had. Dr. Ziem will interview you

about

the situation and fully support your need for a safe environment, even if this

requires testifying against your employer.

 

Obtain a copy of the ADA Handbook from your Congressperson and read it: it

is for your protection. Also ask your state government whether your state has

any additional laws to protect handicapped individuals. Public employees may

be covered by a different federal law: the Rehabilitation Act of 1973, which

you also can obtain from your Congressperson. Remember, there are over 40

million persons in the U.S. with some handicap: with accommodation, most can

live normal, fulfilled lives. If you have legal questions about the law,

contact

Mary LaMielle at National Center for Environmental Health Strategies

(609-429-5358). If you have problems with your employer on accommodation or

harassment, consult an attorney specializing in enforcement of the ADA, such as

Nicole Shultise (410-547-1771). The government's ADA hotline is 800-466-4232.

For

technical assistance on ADA requirements, call 800-526-7234.

8. Controlling Exposures In Your School

 

Chemically sensitive children and adults who wish to attend public or

private school have a legal right to accommodation under the ADA similar to

that

discussed above with regard to the workplace. This protection applies to

dormitories, classrooms and other areas necessary to pursue education. If you

have

a problem with a school environment, contact Dr. Ziem and she will evaluate

the environment, develop an environmental control plan for you, and support

you in any other way necessary.

9. Controlling Exposures In Your Bedroom

 

Since most people spend 7 to 8 hours daily in bed, it is critical that your

bed be non-toxic. Water beds made of plastic can off-gas phthalates and other

chemicals, especially when they are heated, as is often the case. Even

regular mattresses with synthetic covers or slip covers can be a source of

toxic

off-gassing. Ongoing exposure to chemical offgassing can cause increased

illness in chemically sensitive persons.

 

The ideal non-toxic bed has a frame made of metal or untreated, solid wood

and a cotton mattress or futon, preferably made from cotton grown without

pesticides (sometimes called " organically grown cotton " ). The mattress also

should not have been treated with pesticides or other chemical additives, which

are typically used for preserving commercial mattresses. Note that a doctor's

prescription is required to obtain a mattress that has not been treated with

fire-retardant chemicals. Since foam pillows also can offgas chemicals, they

should be replaced either with all-cotton pillows (from " organically grown

cotton " ) or--if you are sure you are not allergic to dander or feathers--with a

down or feather pillow (if the animals have been raised without pesticides

and the feathers, down, and cloth have not been chemically treated). When

buying new linens (or clothing), you also should avoid permanent press fabrics

and

look for " organically grown cotton. " Never use a fabric softener when

washing your bed linens or clothing as these products also can irritate

chemically-sensitive individuals. For more information, read Success In The

Clean

Bedroom, by Natalie Golis, published by Pinnacle (Rochester NY). Organic cotton

clothing and linens can be ordered from Jantz Design (707-823-8834), Dona

Designs (214-235-0485), and Heart of Vermont (800-639-4123).

10. Controlling Other Exposures In Your Home

 

If your chemical sensitivity is severe enough to significantly interfere

with one or more major life activities (e.g. work, housework, errands, school,

etc.), this qualifies as a handicap under the Fair Housing Act and you are

protected by this law from discrimination in housing. Whether you live in a

house, apartment, condominium or trailer, if the dwelling is managed by another

party (e.g. an owner or building manager), they must make reasonable

accommodations to provide you with a non-toxic environment under the

anti-discrimination provisions of the Fair Housing Act. Non-toxic

accommodations have been

upheld by the courts as " reasonable " for MCS patients. Listed below are the

accommodations that you should request in writing from the housing manager or

owner. Of course, if you are the owner/manager of your own property, you should

immediately implement these changes yourself. Dr. Ziem's patients in the

Maryland/DC area are encouraged to take advantage of an environmental home

inspection service offered by Dan Jerrems (410-633-6769), a Physician Assistant

trained by Dr. Ziem who also has extensive experience in environmental and

non-toxic products.

 

Once you've notified your landlord or building manager about your specific

needs, they have a legal responsibility to try to accommodate you. This may

include providing non-toxic housing for you in a transition period until the

problem can be corrected, providing you with additional charcoal filter

capacity in your living area to reduce air contamination of your living space

and

belongings, doubling building ventilation for interior contamination for up to

a year, and switching to less toxic alternatives as recommended by Jim Nigra

or other experts. If you notice ongoing violations that cause your symptoms

to worsen, you may wish to pursue your legal rights with the Justice

Department in Washington, D.C. (202-514-4736). If you have been rendered

seriously ill

by violations, the responsible party should have to pay for an intensive

sauna detoxification program for you if Dr. Ziem feels that is medically

necessary (see Using Exercise and Sauna, below). If you need housing

accommodations,

contact Dr. Ziem, she will fill out a special form and support you in

whatever other ways are necessary. Housing accommodations to request (or pursue

yourself) include the following:

 

A. No petrochemical pesticide or herbicide use should be allowed on the

building grounds, in any common-use areas of your building, or in any other

building areas that share a common air supply with your living area. It is NOT

safe for them to notify you first and then spray, since pesticide residue

lingers for week and can contaminate the air and thus porous objects (fabrics,

wood, walls, etc.) in your living space. Non-toxic alternatives are available

and

economical to use. For information on these alternatives, see Controlling

Neighborhood Pesticide Exposure, below.

 

B. A no-smoking policy should be enforced in the entry, halls, stairways,

elevators, and other common-use areas of your building (if you have symptoms

aggravated by smoke).

 

C. Only non-toxic cleaning agents should be used in the common-use areas of

your building (no petrochemicals, no chlorine products or other moderate to

severe irritants, and no waxes or finishes containing petroleum products). For

information on less toxic alternatives, consult with Jim Nigra of Nigra

Enterprises (818-889-6877). Information also is available in Less Toxic Living

and Non-Toxic and Natural (see required reading, above).

D. No dry cleaning should be allowed of fabrics or carpet in common-use

areas, since dry cleaning uses toxic solvents which can offgas for days. Steam

cleaning should be used instead, using only non-toxic cleaners.

 

E. No petrochemical " air fresheners " should be used in common-use areas. Any

spray or solid " air freshener " is probably a petrochemical. If in doubt, ask

your local Poison Control Center about the brand name. They may not have

expertise on MCS but they can tell you whether or not any specific brand of

product contains a petrochemical ingredient (unless the manufacturer has listed

it as a trade secret or otherwise failed to disclose it). They also can usually

tell you what percentage of the total product is made up of petrochemical

ingredients.

 

F. No petrochemical-containing products should be used for repair,

maintenance, construction or remodeling in any common-use areas or areas that

share an

air supply with yours. These materials also should not be used in outdoor

areas near your windows or other air-intake that might contaminate your air

supply. Examples of products to be avoided include pressed wood and plywood

(formaldehyde and toxic glues), fiberglass (formaldehyde), some other insulation

(if treated with formaldehyde, phenol or other petroleum products), many

paints (if they contain solvents or petroleum additives, fungicides, etc.),

wall-to-wall carpets (because of toxic adhesives, offgassing from latex

backing),

many roofing compounds, many sealants, many coated fabrics. Alternatives are

available; for more information contact Jim Nigra (818-889-6877) or other

experts in non-toxic building materials such as Mary Oestel (512-288-2369),

architect Hal Levin, the publisher of Indoor Air Bulletin (408-426-6624).

 

G. Minimize exposure to exhaust from heating systems and appliances that use

natural gas, oil or wood. If your dwelling is heated with oil or gas or if

you have appliances (washer, dryer, hot water heater, etc.) that use natural

gas, you are being exposed to petrochemicals in your home even when the devices

are functioning normally. A malfunction could cause even greater levels of

exposure and burden you with months or years of added disability. If these

appliances cannot be replaced by solar or electric devices, consider relocating.

Wood stoves and fireplaces should not be used since combustion products

aggravate symptoms, and under no circumstances should you use kerosene or other

liquid-fuel-burning portable heaters. Even portable " radiators " that use

electricity may contain chemicals which can leak out and also, therefore, are

not

recommended. While the replacement of heating systems and major appliances

can be expensive, these changes may be a necessary investment to protect your

health (and future earning capacity). Dr. Ziem considers safer heating devices

and appliances to be medically necessary expenses. Most medical insurers

don't cover them, of course, but they are legitimate medical expenses in many

cases for persons who become ill because of a workplace exposure, home

contamination caused by another party, manufacturer negligence (toxic product,

inadequate warning or labels, etc.), and certain other circumstances. Consult

an

attorney to discuss your legal rights.

 

H. Keep common areas (and your living area) well-vacuumed and free of dust

as chemical contaminants can cling onto house dust for long periods, allowing

them to be stirred up and recirculated.

 

I. If you read a lot of newly printed papers, books or journals, consider

using a reading box to control your exposure to ink and paper offgassing

(available from Safe Haven 800-280-6519). Store printed materials in relatively

airtight containers whenever possible: metal trash cans or used " ammo " boxes

from army surplus stores can be used. If working at a table or desk, place it

in

front of an open window , and have only the necessary printed matter for the

task you are working on in front of you.

J. If you buy new cottons that bother you, a " pressure cooking " method can

remove some or most of the offending chemical, mold, etc. Be certain the new

clothing is one size too large for you, because it will shrink. You may want

to test a button before washing; they might be damaged.

1. Fill a large pressure cooker with water, adding 3T tolerated detergent,

1/2C Borax or baking soda and clothes.

2. Heat to pressure on a range, then put it outside on a hot plate for 1-3

hours at maximum pressure (15 p.s.i.).

3. Let it cool or hose it down till the pressure is zero, crack open the

lid, then pour off the horrible smelling brown soup of cotton oils and

chemicals.

4. Do steps 1 and 2 again (Skip this for older clothes).

5. Do a rinse cycle, then a full wash cycle, then dry.

Clothes might require one more wash/dry cycle, but probably not. Elastic is

not ruined.

Colors will bleed a bit, but plaids are still plaid _[6]_

(http://www.mcsrr.org/resources/articles/S3.html#6) .

 

Garments with residues of scented products, formaldehyde and certain other

contaminants can be rendered less toxic by washing with powdered milk added to

wash water. This also helps residue smells in green cotton and even organic

cotton.

K. Research by NASA shows that certain plants can help reduce pollution.

(NASA removed polluting sources and used activated charcoal filters as well).

Boston fern, pot mums, dwarf date palm, and spider plants worked well for

formaldehyde and certain other pollutants. Other good pollution-fighting plants

include peace lily, golden pathos, English ivy, aloe vera, philodendron and

Chinese evergreen.

11. Controlling Air Quality

 

AIR FILTERS: There are special air filter devices that can greatly assist

persons with chemical sensitivity. The best filters contain " activated

charcoal " that will " soak up " (adsorb) toxic chemical vapors from pesticides

and

other chemical products made of petroleum or coal. You may need an additional

filter in your device for formaldehyde if your original sensitivity began with

an exposure to formaldehyde (in fiberglass, particle board, carbonless copy

paper, formaldehyde treated fabrics, etc.), or if your home is located near a

major highway (since traffic exhaust contains formaldehyde). If you have

allergies to pollen, dust, or other airborne particles, if your home is located

near a main road, or if you are bothered by fireplace or other smoke, you also

may need a " particulate " filter that can trap small particles.

 

All these filters are considered medical devices and, if medically necessary

for your health, will be prescribed by Dr. Ziem. If your insurance carrier

reimburses for other medical devices but refuses to reimburse for these, Dr.

Ziem considers this a form of discrimination against chemically sensitive

persons (unless the policy specifically excludes all filter devices, including

those for persons with asthma). If you have carefully reviewed your insurance

policy and feel your insurer is reimbursing for other medical devices,

especially other filter devices (you should ask if they cover filter devices

for

people with asthma), but they refuse to reimburse for your filter, contact an

attorney specializing in " bad faith " cases against insurance companies such as

Alan Casper in Philadelphia (215-994-1771). It is also possible that the

vocational rehabilitation department of your state or locality may fund or

advance funds for filters (and/or sauna, see below) as part of an effort to

rehabilitate you for work. If Dr. Ziem has recommended the filter device for

you,

she will stand behind your medical need for it. Activated charcoal filter

devices are considered effective in helping pollutant control by NASA _[7]_

(http://www.mcsrr.org/resources/articles/S3.html#7)

 

Using air filters does not necessarily mean all your windows should be kept

closed, unless you know you would be made sick from nearby pollution. Outdoor

air is good for you if not polluted; try opening the windows in your bedroom

for a few weeks to see if you feel better (but close them if the exposures

bother you). Note that, in some cases of interior contamination, ozone

generators may be helpful, but these CANNOT be used while you are in the

building

because of the irritant effect of the ozone on your respiratory system (even at

levels too low to smell). The building also must be very well ventilated

after the ozone generator is turned off and before you return-- for 48 to 72

hours at a minimum. Do NOT use an ozone generator without first consulting Dr.

Ziem.

 

Buying house and room filters: Air filter devices should be located at least

in rooms where you spend a lot of time, such as the bedroom or other

sleeping area. If you can afford it, try to install filters in each of your

other

major living areas. They will reduce damage to your health caused by air

pollution from neighborhood pesticide treatments, fireplaces, highway traffic,

industrial and commercial emissions, and so on.

 

The most effective approach is a filter system for your entire home,

especially if you own your home. If your illness is severe enough to interfere

with

your ability to work, you probably need a whole house system unless you live

in a relatively non-polluted area. Probably the least expensive whole house

filter system is manufactured by the Thurmond Air Quality Systems in Texas

(800-247-7873).

 

The capacity of most portable (room-sized) filter devices is rated in cubic

feet. To determine the number of cubic feet you need to filter, measure the

room's length, width, and height in feet and multiple these numbers together

(length x width x height) to get cubic feet. DO NOT buy a portable filter

device from a hardware store, department store, mail order catalog, or other

supplier that does not specialize in filters for chemically sensitive people.

These devices can contain toxic products. We recommend that you purchase

portable filters through Nigra Enterprises (5699 Kanan Rd, Agoura CA

91301-3328;

phone 818-889-6877), which specializes in protective products for the

chemically

sensitive. Owner Jim Nigra is familiar with various brands and will help you

select the most effective and economical device(s) from a range of

specialized manufacturers. Call Dr. Ziem if you encounter any unresolved

problems with

his service; to date this has not occurred.

 

Sometimes persons who are quite sensitive to many things notice a problem

with certain types of charcoal: you should request samples to test or exchange

your filter if this occurs. Some particulate filters such as HEPA filters may

have glues which bother some individuals even though filters recommended by

NIGRA are designed for chemically sensitive persons. If you notice any

increase in symptoms after your filter arrives that seem worse around the

filter,

contact Mr. Nigra immediately. Remember, the usual pattern is gradually

feeling better with the filter: if you are worse around it, something is wrong.

 

CAR FILTERS: You also may want to consider purchasing a filter for your car,

especially if you have increased symptoms after being in traffic. These

devices plug into the cigarette lighter attachment of your car and filter air

inside the car. The windows must be closed to use this system, however, so it

may be impractical in hot climates unless your car is air conditioned. Some

patients also find it helpful to have their car's engine steam cleaned, since

" fresh " air drawn into the car's interior through intake ducts in the engine

area may be contaminated with grease and oil from engine surfaces.

 

AIR FILTERS TO AVOID-IONIZERS: Ion generators act by charging the particles

in a room so that they are attracted to walls, floors, tabletops, draperies,

occupants, etc. Abrasion can result in these particles being resuspended into

the air. In some cases these devices contain a collector to attract the

charged particles back into the unit. While ion generators may remove small

particles (e.g. those in tobacco smoke) from the indoor air, they do not remove

gases or chemical vapors and may be relatively ineffective in removing large

particles such as pollen and house dust allergens. Although some have suggested

that these devices provide a benefit by rectifying a hypothesized ion

imbalance, no controlled studies have confirmed this effect. Ion generators

also

create ozone, an irritant to the air passages.

 

AIR FILTERS TO AVOID-OZONE GENERATORS: Ozone, a lung irritant, is produced

indirectly by ion generators and some other electronic air cleaners and

directly by ozone generators. While indirect ozone production is of concern,

there

is even greater concern with direct, and purposeful introduction of a lung

irritant into indoor air. There is no difference, despite some marketers'

claims, between ozone in smog outdoors and ozone produced by these devices.

Under

certain use conditions, ion generators and other ozone generating air

cleaners can produce levels thought harmful to human health. A small percentage

of

air cleaners that claim a health benefit may be regulated by the FDA as a

medical device. The Food and Drug Administration has set a limit of 0.05 parts

per million of ozone for medical devices. This level may not be safe for the

chemically sensitive. Although ozone can be useful in reducing odors and

pollutants in unoccupied spaces (such as removing smoke odors from homes

involved

in fires) the levels needed to achieve this are above those generally thought

to be safe for humans.

 

Respirators & Masks: It may sometimes be necessary for you to wear a simple

" nose/mouth " mask or respirator in order to reduce your personal exposure in

environments that are contaminated beyond your control. Sometimes these types

of exposures are unavoidable, and if the unavoidable exposures make you ill,

you should definitely try using a respirator to reduce your exposure.

Examples of such situations are running into a store for errands and feeling

sick,

or getting caught in traffic and feeling sick (but don't use a mask as a

substitute for a car filter).

 

Well-fitting masks are made by 3M but not everyone can tolerate them,

because they are made of synthetic materials. For lighter exposures, Jim Nigra

recommends a lightweight " nuisance odor " mask with a small amount of charcoal

(#9913). For heavier exposures, you should use a thicker mask with more

charcoal

(#8709 which also, unfortunately, is bulkier and heavier). These can be

ordered from Nigra Enterprises (818-889-6877).

 

For people who cannot tolerate the 3M mask, cotton and silk ones are

available with a space to insert a packet of activated charcoal. These can be

ordered from Sandra DenBraber, R.N. (817-860-9299). All masks containing

activated

charcoal should be kept in an air tight metal or glass container when not

being used; otherwise the charcoal will continue to pick up chemicals even when

you are not wearing it, greatly shortening its useful life.

 

We do not recommend disposable " dust " masks as these do not filter out

chemical vapors.

 

Humidifiers: Humidifying the air can reduce dryness of the mouth, nose and

lungs in the winter. However, chemically sensitive persons should use only

water that has gone through an activated charcoal water filter (or well water

that is not chemically treated) so their humidifiers do not mist solvents into

the air. If you have a history of allergy to mold, try to find a humidifier

in which the water constantly circulates, as mold can grow easily in those

types that hold standing water. Do not clean the humidifier with

chlorine-containing products (e.g., Comet, etc.), Or with other cleaners

containing

petrochemicals: consult Less Toxic Living for safer cleaning agents. If you

notice

any symptoms you think may be aggravated by your humidifier, try turning it off

for about a week and compare your symptoms. If they decrease during that

week and increase when you turn it on again, contact Dr. Ziem or Jim Nigra

(818-889-6877) for recommendations.

 

READING BOXES: Patients who experience illness when exposed to ink in

newsprint or other printed material can obtain a " reading cabinet " from The

Living

Source (817-756-6341) that allows reading, writing and even typing with

greatly reduced exposure. Other enclosures are available to trap emissions from

computers, printers and fax machines. Contact Jim Nigra (818-889-6877) for more

details.

12. Controlling Water Quality

 

Chlorine used in water treatment reacts with organic (natural) material in

the water to form new chemicals like chloroform and other toxic substances.

These may aggravate chemical sensitivity when breathed in from shower vapors or

ingested via drinking and cooking. Since a lot of exposure occurs during

showering and bathing, you should consider installing showerhead and faucet

filters (available from Nigra Enterprises, above) or a whole-house water

filtration system, which would also treat water used in clothes-washing and

dishwashing machines (these uses also release chemicals into your home). Some

people

further reduce drinking and cooking water exposures by either using bottled

water (which can get expensive) or installing an extra-effective filter on

their kitchen tap. If such a filter is used in addition to a whole-house

system,

the filters will not need to be replaced very often and the water will taste

better. Nigra Enterprises recommends and sells whole-house water filtration

systems made by Ametek Equipment, Coast Filtration, and General Ecology.

13. Using Exercise And Sauna To Eliminate Toxins From Your Body

 

As exercise breaks down body fat, it releases the petrochemicals stored in

fat which then enter the bloodstream. While these chemicals are partly sweated

out during exercise, more can be sweated out if the exercise is followed

immediately by a sauna. Medical studies of chemically-exposed persons have

shown

that sweating induced by the regular use of saunas can gradually reduce the

level of pesticides and other toxic petrochemicals in the body. Although

filters and other environmental controls can reduce new exposures to

petrochemicals, sauna and exercise are the only treatments that can reduce the

total

level or " body burden " of chemicals already in your body.

 

A small and relatively inexpensive sauna made by the Radiant Heater Company

designed specifically for chemically sensitive persons can be obtained from

Nigra Enterprises (818-889-6877). This utilizes a low temperature range

(110-120 degrees F) which warms superficial fat and induces better excretion of

fat

soluble petrochemicals than higher temperature saunas, which cause more

water loss. With low temperature, sauna time is longer (30 minutes to one

hour).

Dr. Ziem's patients have improved significantly with sauna therapy and she

now regards this as a medically necessary treatment for chemically sensitive

persons. Insurers who cover medical devices should reimburse for this; it will

save them money in reduced future medical costs. You will probably need a

prescription from Dr. Ziem for the sauna. (Do not purchase a regular commercial

sauna). Do sauna during cooler months: during warm and hot months the body

will sweat without sauna. You can dress slightly more than usual when walking

outdoors to slightly increase sweating: simply return home and shower.

 

Unfortunately, commercial saunas such as those used in gyms and health spas

rarely help chemically sensitive persons because they are cleaned with

chlorine-containing or other irritating and/or toxic chemicals. They are also

often

contaminated with cosmetics and other products containing petrochemicals

from previous users. Also remember: a hot tub is NOT a sauna. Hot tubs contain

chlorinated water and are also treated with chemicals that can react to form

toxic compounds in the water.

 

If--after beginning sauna therapy--you experience a rash in the areas of

greatest sweating, this is probably due to excreting chemicals through your

skin. Unless this is minor, reduce your sauna time for a while. The rash should

improve as your body burden (and thus chemical excretion) declines.

 

Another sauna designed for the chemically sensitive made by Fred Nelson

(517-697-3989) is slightly less expensive. Its disadvantages are that it is a

lying down model (easier to fall asleep), that it cannot be returned and that

the unit does involve a small motor (used outside the sauna space). It has a

zipper enclosure. If you use it, it MUST be used with a Dayton mechanical

windup half hour timer (part #6X763) available from 410-391-9000 for about $22.

The heating unit MUST be plugged into the timer so that it automatically shuts

off at 30 minutes. The zipper can be opened about 4 " at the head end to allow

you to look out and watch TV (TV laying on its side). This sauna achieves

temperatures of 120-140 degrees F, compared to about 110-120 degrees F for the

Radiant Heater sauna.

 

Sauna procedure--FIRST EXERCISE: You need to exercise in a relatively

non-toxic setting, because you breathe deeper and faster during exercise and

your

lungs will breathe in more pollutants. Non-toxic settings include your home,

especially if you have filters and don't have a home contamination problem.

Exercise videos and exercise machines can be used. Even with filters, however,

the average indoor environment is often more contaminated than a non-toxic

park. Walking in a park that is not pesticide sprayed or close to heavy traffic

is great exercise; just sauna immediately after coming home. If you are

unable to locate a non-toxic park or other outdoor walking exercise, please

contact Dr. Ziem's office at (410) 633-6769. She can request your local park(s)

to

stop using toxic pesticides and other lawn care products as an accommodation

of your MCS disability. NOTE THAT SPENDING TIME IN NON-TOXIC OUTDOOR

SETTINGS SEEMS TO SPEED RECOVERY in Dr. Ziem's MCS patients. You should begin

exercising at a level comfortable for you. Don't " push " yourself; as you get in

better condition, you can gradually increase the vigor or time you exercise. If

you are over 35 years old and have not exercised recently, if you are over 50

years old (regardless of exercise status), or if you have a history of heart

disease or high blood pressure, any exercise more vigorous than walking

should be discussed first with your physician. In any case, you don't need to

exercise until you " sweat " since the sauna will take care of that.

 

THEN SAUNA: Drink 12 oz. of water and then enter the sauna immediately after

completing your exercise. If you use the Fred Nelson sauna, plug it into a

1/2 hour timer. Begin with about 10-15 minutes. If you experience any

discomfort or dizziness, leave promptly. If you do fine for 2 weeks at 15

minutes,

increase to 20 minutes if you wish. If you have no ill effects at all in the

sauna, you can gradually increase to a maximum of 45 minutes (increasing the

time by not more than 5 minutes each week). The temperature in the Radiant

Heater sauna can be increased up to 130 degrees by putting a 100% cotton (or

100%

wool) blanket over the cloth enclosure. Put a small towel on the bench where

you sit so your sweat does not contaminate the sauna. One exercise/sauna

procedure per day is usually sufficient. Try to sauna at least 5 to 6 days per

week: you can do it every day if you wish. Remember that your body gradually

adjusts to heat but can lose most of this adjustment in a few days. Thus, if

you skip more than a day between saunas, cut back the time or temperature from

your last sauna. Some saunas contain " hot rocks " ; if you put water on these

to create steam, the water should be charcoal filtered (or chemically

untreated well water) to avoid releasing solvents in the sauna area. SET A

TIMER TO

AVOID THE RISK OF FALLING ASLEEP IN THE SAUNA. Drink another 12 oz. of water

to avoid a headache.

 

THEN SHOWER: Immediately after completing your sauna, enter the shower. Soap

up your scalp and entire body with a non-toxic soap and rinse off

thoroughly, rubbing your skin with your hand, washcloth, or a loofa to remove

the

contaminated sweat and soap. (Clean the washcloth well after each shower.) Your

shower water should be treated with a showerhead or whole-house filter so that

you are not exposed to solvents or chlorine during your shower (see Improving

Water Quality, above). Bathing is NOT recommended for women because bladder

infections occur easily with women sitting in a bathtub. Showering, in any

case, is probably a more effective way to remove contaminants from the skin for

both men and women. If skin dryness occurs, use a non-toxic skin softener

such as " organic " olive oil (grown without pesticides).

14. Controlling Exposures In Food

 

Pesticides used in agriculture are very toxic to chemically sensitive

persons and cause increased changes in the nervous system and other organs.

Unfortunately, most commercially grown foods have significant pesticide

residue.

This is typically spread throughout the food and cannot be effectively removed

by scrubbing, peeling, etc. The Environmental Working Group (a D.C. non-profit

agency) found significant pesticide levels on many fruits and vegetables in

the U.S., And provided evidence of underreporting this problem by the FDA.

Their report is entitled: " Forbidden Fruit: Illegal Pesticides in the U.S. Food

Supply. " In order to avoid adding to an already excess body level of toxic

chemicals, the chemically sensitive person should eat foods grown without

pesticides and without pesticide treatment (such as fumigation) during storage,

shipping, etc. This food is usually called " organic. "

 

Preservatives, coloring agents, and other food additives also may be toxic

to chemically-sensitive persons. Additives that may aggravate symptoms include

MSG, benzoic acid, parabene (methyl, propyl, butyl, etc.), TABA, BHA, BHT,

BHQ, polysorbate 80, sorbitol, sorbic acid, chlorobutanol, and ethylene oxide.

Foods without these agents are often called " natural, " but foods labeled

natural may not be organic unless also labeled organic. Whenever possible,

purchase organic foods described as without additives, preservatives, etc.

 

Organic foods are often more expensive than contaminated foods, partly

because it takes more labor to grow them and they don't last as long on the

shelf.

Your regular medical insurer does not reimburse for the excess cost of

organic food (just as they don't reimburse for a special diabetic diet).

However,

if your case is work-related or the result of a negligent manufacturer

(dangerous product, product with inadequate warning labels, etc.), Dr. Ziem

feels

that the excess cost of organic food in these situations is a legitimate

medical expense. Thus, keep track of your grocery expenses before and after you

began to purchase organic foods, and consult an attorney to understand your

legal rights in this area.

 

Meats should be from animals raised on organic pastures (without pesticide

treatment) and/or fed grain that has not been grown or treated with any

pesticide. This is very important for meat, since the chemicals found in

non-organic grains tend to build up (or " bioaccumulate " ) in the animals that

eat them.

Animals also should be raised without antibiotics, hormones and other

synthetic chemicals. Ask for a written statement from the grower and/or

supplier to

ensure a safe meat supply.

 

Fish from the ocean are less polluted than fish from fresh water in most

cases (a sad commentary on " freshwater " pollution). Also, shell fish (such as

scallops, shrimp, crabs, lobsters, clams, and oysters) dwell on the bottom

where toxic chemicals tend to accumulate, so they are more polluted than most

seafood. This also applies to flounder, which lays on the bottom. Fish that eat

other fish (carnivores) tend to be more toxic than those that eat plants,

since when carnivores eat other contaminated fish the chemicals concentrate in

their flesh. Most fish, however, are still more healthy for your heart than

red meat. For information about organic foods in Maryland, contact the Maryland

Organic Farming Association (301-371-4814). For other states, contact the

National Committee Against the Misuse of Pesticides (202-543-5450) or the

National Center for Environmental Health Strategies (609-429-5358). It is

preferable that foods not be stored or microwaved in plastic containers or

plastic

wrapping (use less toxic cellophane made from wood, available from NEEDS,

1-800-462-6333).

 

BRAIN-DAMAGING FOODS--EXCITO-TOXINS: There are certain food substances which

are similar in chemical structure to body substances which transmit nerve

messages (neurotransmitters). These food substances can cause such excess

stimulation of nerve cells that the nerve cells actually die from

over-excitation

and exhaustion. These substances are known as excito-toxins. People at

greater risk include children, those with low energy levels, and persons with

chemical injury (since this injury weakens the brain's protective " blood-brain

barrier " ). Some evidence suggests that chronic intake of excito-toxins

increases

risk of Parkinson's, Altzheimers and other degenerative diseases of the

nervous system.

 

 

Excito-toxins include aspartame (Nutra Sweet) and monosodium glutamate

(MSG). Unfortunately, MSG can be in foods WITHOUT being listed on the label.

Additives that contain MSG (without listing MSG on the label) include autolyzed

yeast, yeast extract, calcium caseinate, sodium caseinate, hydrolyzed protein,

hydrolyzed oat flour, hydrolyzed plant protein, plant protein extract,

hydrolyzed vegetable protein and textured protein. MSG is usually contained in

bouillon, broth, flavoring, malt flavoring, malt extract, natural beef or

chicken

flavoring, seasoning, stock, again without any mention on the label.

 

MSG kills nerve cells by allowing excess calcium to enter the cell. Animals

exposed to MSG become obese even with modest or lower food intake. Since

Nutra Sweet can have the same effect, people consuming excito toxins may be

unable to lose weight normally by dieting.

 

Excito toxins in liquid form (soups, beverages) are more dangerous, since

they are rapidly absorbed. Glutamate from MSG remains high in human blood

longer than in any animal tested. Junk foods contain the highest levels.

 

Other brain stimulants to avoid are caffeine, coffee, chocolate, some

headache medicines, many cold medicines, appetite suppressants and wake-up

pills.

 

Reduce your exposure by reading all food labels, reducing consumption of

pre-prepared foods, and asking the manufacturer in writing about MSG and

aspartame when in doubt. Also learn more by reading the book: Excito toxins:

The

Taste That Kills, by Russell Blaylock, M.D., a neurosurgeon.

TOXINS IN FOOD: Chemical sensitive patients evaluated by Dr. Ziem have shown

impaired ability of the liver to detoxify toxic substances. Some food pr

eparation methods can increase toxins in foods.

More toxins are generated by:

1. Meats, fish that are grilled, blackened or smoked

2. Meats with more fat

3. Meat and fish cooked at higher temperatures (over 150-200°

C)--higher temperature pan frying, broiling, hot deep fat frying, etc.

4. Meat, fish and fats/oils cooked with water allowed to evaporate

(open pan frying)

5. Beef stock, flavors, commercial sauces, vegetable stock or

hydrolyzed vegetable protein

6. BHT in food

Thus a commercial hamburger or hot dog with french fries is often a " toxic

meal " .

REDUCE TOXINS BY covering food when cooking, use lower temperatures for pan

frying and use low fat meats. Milk, cheese, eggs, beans, peas, soy are

protein sources that are less toxic with cooking. Best cooking methods are

boiling

in water, steaming without first browning, poaching or microwaving (in

glass).

Substances which help protect your body from toxins include quercitin,

catechin, flavones and flavonols, tochopherols and other antioxidants. Roasting

and baking yield low to intermediate levels of toxins, as does low temperature

pan frying. (Source: Robbana-Barnat, S. " Heterocyclic anines: occurrence and

prevention in cooked food " , Env. Health Persp 104:282-288, 1996).

 

FOOD INTOLERANCE: Many patients with chemical sensitivity feel that certain

foods aggravate their illness. Such foods are often those they eat most

frequently, even daily, such as milk and dairy products, wheat, corn, apples,

etc.

People with food-related symptoms, sometimes called " food intolerance, " may

experience reactions up to 18 hours after eating, though usually sooner. If

you suspect that certain foods may aggravate your illness, you should try

eliminating these one by one from your diet for 4 or more days. Then you may

eat

the suspect food just once again, but carefully measure your pulse before and

after doing so (by feeling the wrist or the artery in the neck and counting

a full minute using the second hand of a watch or clock). Also compare your

eyes for swelling (bags or circles) and look for any changes before and after

in your mood (restless, irritable, sleepy, etc.). If you think you have

identified a problem food, wait at least 4 days again to get it out of your

system

and then you may try eating again if you wish.

 

Another way to evaluate for food intolerance is a " diagnostic rotating diet "

(our term). In this approach, food groups are eaten only once in 4 days,

recording symptoms. Problem foods are checked for and eliminated, if any. If

you

feel much better eliminating certain foods, we feel you are probably

intolerant to them. The procedure is complicated, since food groups must be

understood, as well as interpretation of symptoms. If you wish to follow this

approach, we would refer you to Natalie Golas (301-948-1116) who has years of

experience doing this for MCS patients. For some patients, this can make a

significant difference, especially more severely ill patients.

 

To track your food sensitivities, you also can keep a food diary, listing

what you ate at each meal, what symptoms you noticed, and when. Some patients

try a " rotating diet, " not eating the same food more often than once every

four days. If you stick to a regular rotation diet, you can more easily track

any adverse reactions due to newly introduced foods. Remember, as discussed

above, to eat only foods not grown with pesticides whenever possible, as

pesticide residues also may cause serious reactions which are sometimes

confused

with food allergies. Also read all labels very carefully to screen out prepared

foods that contain ingredients your are trying to avoid (such as corn, wheat,

and/or milk). More information on foods is in the book Success in the Clean

Bedroom by Natalie Golis.

 

PLASTIC CONTAINERS: Food stored in plastic containers can become

contaminated with the petrochemicals in the plastic (Kailin, Medical Annals of

D.C.,

October 1964). Store food in glass or metal containers whenever possible, or in

cellophane bags made from wood (cellulose). This can be obtained form NEEDS

(800-634-1380). Natural or wood-based cellophane tears more easily than

plastic but after a few trials you will be able to use the bags multiple times.

Secure bags tight by twist tie or doubling over and sealing with non-toxic tape

(this seems to keep food best). They may be used for freezing also. Glass can

also be used for freezing if at least one and one-half to two inches of air

is left at the top.

15. Controlling Exposures In Your Medical Care and Medications

 

Dr. Bill Meggs, an ear, nose and throat specialist who has conducted

research on chemical sensitivity, has found typical sinus inflammation on

biopsy--including swelling, redness and " cobble stone " changes--in almost all

of his

MCS patients. In Dr. Ziem's experience, it is common for doctors to misdiagnose

this inflammation as a bacterial infection and prescribe treatment with

antibiotics. Because chemically sensitive patients often develop reactions to

antibiotics and other synthetic medications, and seem susceptible to yeast

infection with antibiotic use, it is important that the doctor do additional

tests

to determine whether or not bacterial infection is in fact present. This can

be done by performing a white blood count. Typically with bacterial

infection, the white blood count is increased and there is an increase in the

number

of neutrophils, the type of white blood cells that responds to bacteria. If

the neutrophils are not increased in percent or in number it is unlikely that

the infection is bacterial. In this case, Dr. Ziem recommends reducing

exposure first to see whether symptoms improve before using any antibiotics,

especially since antibiotics may cause side effects and drug sensitivity

reactions.

This may also help prevent the frequent problems of yeast or candida

infections that often plague chemically sensitive persons after multiple doses

of

antibiotics.

 

Patients who notice tightness of the airways with difficulty getting enough

air, chest tightness and shortness of breath are sometimes given inhalers by

physicians to open up the airways. Unfortunately, most of these inhalers

contain petrochemical propellants which can aggravate illness in chemically

sensitive patients. Doctors should avoid prescribing inhalers with

petrochemical

propellants. If your doctor feels that this is necessary, he or she should

document that your lung function does actually improve with the inhaler and

that

you do not experience side effects from its use. This is typically done with

a lung function test such as flow rate.

 

In Dr. Ziem's experience, irregularities of the heart beat and/or rapid

heart beat are common in chemically sensitive patients after exposures. While

medications for these symptoms are available, they do not seem to work as well

in chemically sensitive patients. Unless the symptoms are life threatening,

therefore, Dr. Ziem recommends controlling the environment instead, which is a

safer and more effective preventive measure.

 

Many medications can interact with other petrochemicals and/or affect the

way the body is able to get rid of petrochemicals from the environment. It is

important that you share this section with your physician because it has been

written with your doctor in mind. Phenol often increases symptoms in

chemically sensitive persons and is found in medications such as certain throat

lozenges, calamine lotions, some antacids, and phenol-camphor petrolatum

lotions.

Whenever possible, phenol should be avoided. Substances such as phenacetin,

acetanilide, and the disinfectant phenazopyridine are metabolized to

petrochemical-like substances which sensitive persons may find problematic.

 

Medications that reduce certain liver enzymes (P450 enzymes) can cause

pollutants to build up in the body. These enzymes include barbiturates,

benedryl,

amantadine, and indomethacin, as well as aspirin, cimetine, and propranolol.

Medications which cause an increase in the P450 liver enzyme system can cause

a problem for certain other chemicals which are broken down faster to toxic

" intermediate " chemicals. These medications include phenobarbital, phenytoin,

carbamazepine, meprobamate, amobarbital, glutethimide, antipyrine,

phenylbutazone, testosterone, rifampin, griseofulvin, and others. Some

medications

reduce blood flow to the liver, which makes it more difficult to metabolize

some

pollutants. These include propranolol and cimetine.

 

Medications which increase liver blood flow can cause a problem with certain

chemicals. These include adrenergic medications such as epinephrine and also

nicotine and caffeine. Medications that are tightly bound to proteins in the

body can displace chemicals which are bound to proteins and, thus, make the

chemicals more available to act on the body. These medications include

aspirin, sulpha drugs, and phenylbutazone. Medications that inhibit the body

enzyme

cholinesterase make the individual more susceptible to pesticides containing

organo-phosphates or carbonates. Such medications include eye drops for

glaucoma and medications for myasthenia gravis. The ability of the body to

excrete pollutants depends upon the urine not being too alkaline or acid: thus,

medications that affect the urine acidity can influence the body's ability to

excrete pollutants. These medications include ammonium chloride, sodium

bicarbonate, thiazide diuretics, and acetazolamide. The medications listed above

are examples of medications that act by different mechanisms and are not

intended to be a comprehensive listing of all medications that can affect the

body's handling of all pollutants. Thus, before taking any medication, please

review these mechanisms with your physician.

 

Chemically sensitive patients can become very ill with the use of

anesthesia. Anesthesia typically involves a significant dose of synthetic

chemicals to

cause unconsciousness. Patients can remain ill for weeks or months following

general anesthesia. For many individuals, acupuncture can provide adequate

pain control for surgical procedures. The following is a list of acupuncturists

in the Maryland area that you may want to contact. Note that this listing

does not imply Dr. Ziem's recommendation or endorsement:

 

Dr. Cheng (202) 775-1108

Floyd Herdrick (703) 978-4956

David Godel (410) 657-2389

Dr. Trent (202) 659-0515

Dr. Wu (202) 363-2455 c/o Jo-Ellen Hamden

16. Controlling Neighborhood Pesticide Exposure

 

Many chemically sensitive persons become ill from petrochemical pesticides

used by their neighbors. Maryland and some other states (CO, CT, LA, MI, NJ,

PA, and WV) have laws requiring that you receive advance notice for nearby

commercial pesticide application if you so request: see the sample request form

in your patient packet of materials for Maryland. Contact the National

Coalition Against the Misuse of Pesticides (202-543-5450) for information on

other

states. Some states only cover properties bordering yours. This is inadequate

for many patients. Try explaining how toxic pesticides are to your neighbors

by focusing on their own health, their children, their pets, etc. Most

people don't know that pesticides easily enter the body through the skin, that

they remain as a toxic residue for days, weeks or longer, that many cause

nervous system and/or immune damage, and that even pesticides shown to cause

cancer

or birth defects are still marketed and sold as " safe. " When your neighbors

realize these things and learn about the non-toxic alternatives available, it

is much easier to create a less toxic neighborhood safe for roaming children

and pets as well as adults. Let them know that children in homes using lawn

pesticides were four times more likely to develop sarcoma cancers (soft

tissue cancer) and children whose parents used pest strips were twice as likely

to

develop leukemia _[8]_ (http://www.mcsrr.org/resources/articles/S3.html#8) .

 

PESTICIDE ALTERNATIVES: Bill Currie of the Institute of Integrated Pest

Management (301-753-6930) has many years of experience assisting building

managers and persons with chemical sensitivity in developing non-toxic pest

control

programs for both grounds (lawns, etc.) And buildings. He can provide an

economically feasible and low-toxic approach which can greatly reduce risk of

disability and consequent legal repercussions. He has consulted for HUD and Dr.

Ziem on these reasonable accommodations for the handicap of chemical

sensitivity. Other sources of information on alternatives to pesticides include

the

New York Coalition for Alternatives to Pesticides (518-426-8246), entomologist

Albert Green (202-708-6948), William Forbes, the non-toxic pest control

expert for Montgomery County (MD) Public Schools (301-840-8122), and

landscapers

with expertise in non-toxic grounds maintenance, such as Nature's Tailors

(410-655-7821). You also may want to consult Common Sense Pest Control by

Olkowski.

17. If You Need To Move To Another Dwelling

 

If--after pursuing all the above environmental controls--you are still

severely handicapped by exposures in your home or neighborhood--you should

consider moving to a less contaminated environment, even if it means breaking a

lease or other housing contract. (Dr. Ziem can assist you with this, if done

for

medical reasons.) Of course, you also may need to move for other reasons,

unrelated to your illness. Whatever the case, you are strongly urged to:

 

A. Avoid buying any home, condo, trailer or other dwelling until you have

lived in it for at least 12 months to see whether seasonal and other exposures

(pesticides, wood stoves, etc.) are going to bother you. Let Dr. Ziem know if

you need medical documentation to arrange for a one-year trial lease.

 

B. Avoid suburban areas in which chemical lawn treatments are used by

neighbors or local government.

 

C. Avoid high pollution areas near highways, industrial facilities, waste

dumps, etc., And congested urban areas.

 

D. Consider relocating to a wooded area, since plants and trees can help

detoxify air. An ideal location is very close to a state, local or national

park

or forest if pesticides are not used. (Dr. Ziem can help discontinue toxic

pesticide use on such public land as a reasonable accommodation for you.) If

you locate in such an area, keep bedroom windows open at night whenever

possible. Dr. Ziem's patients who live in such areas have improved much more

rapidly than average.

 

E. Choose a dwelling with electric or solar heat and appliances. Dr. Ziem's

patients who use only electric heat and appliances also improve more

quickly.

 

F. Ask for a written statement confirming that the dwelling has never been

treated with chlordane (a toxic pesticide which persists for decades). Also ask

for written records on all other dwelling/grounds pesticide use.

 

G. Consider a dwelling using well water, as long as the dwelling is not

located near agricultural facilities that use pesticides. Patients using well

water seem to do better, although most of them also live in less polluted

areas.

If well water is available, the water quality should be tested first by an

independent laboratory to check for possible chemical contamination.

 

Keep in mind that low income and disabled patients may be eligible to

receive assistance (financial and otherwise) in locating low-toxic housing

through

their state or local housing commission. If this is available to you, be sure

to ask the official(s) you are dealing with to contact Dr. Ziem about

discuss the specific accommodations needed in your case to provide for a

low-toxic

environment.

18. Psychological Counseling

 

Sometimes the home, work, and social adjustments needed by chemically

sensitive persons can strain their (and their family's) psychological ability

to

cope. Fatigue and changes in the nervous system can also impair sexual function

in some persons, and other problems can strain a marriage or family

relations. If you have unsolved problems within your family related to MCS,

please

talk to Dr. Ziem, who is willing to assist you, or ask a support group to

recommend a counselor.

19. Sex and MCS

 

People who are tired and achy often experience problems with sexual

function. A healthy sex life helps the immune system, however. We think you can

enjoy

sex more with the following suggestions. If fatigue or pain are problems,

your partner should assume the positions that require the most energy, and

allow you to be the less active partner. You can still give pleasure by

touching

and kissing areas exciting to your partner. Women can also strengthen muscles

involved in orgasm in the vaginal area. This can be done by trying to

interrupt your stream of urine at least once when emptying your bladder, which

helps build these muscles. (More interruptions build them faster, but may be

hard

at first). (If you can only move one muscle, this is the one!) Also try sex

at times of the day when you are less tired.

If vaginal yeast infections are a problem, consult _section 15_

(http://www.mcsrr.org/resources/articles/S3.html#medical) in this document.

Women can

help avoid developing bladder infections following sex by always emptying the

bladder shortly after sex, by asking the partner to wash hands carefully before

sex, and by asking the partner to avoid touching the vaginal area with a

hand that has had contact with the anal area. For lubricants, synthetics may be

a problem, but you can experiment with butter or vegetable oils made from

foods you are not sensitive to. Incense and perfumes can not be used to set the

mood, but good music, videos or other approaches can work. All natural

(organic cotton, etc.) bedding can reduce coughing and other less romantic

symptoms. As you gradually improve with environmental controls and fresh air,

you

will gain vigor. Regular walking outdoors will help this. Sometime check out

the

movie, Coming Home, which shows a beautiful love scene between a war vet who

is a paraplegic and a beautiful woman. The movie tastefully portrays happy

sex even during this difficult situation. We encourage you to be creative,

patient, and persistent.

20. Oxygen Use During Reactions

 

Some patients with chemical sensitivity who are having a reaction to an

exposure feel reduced symptoms with oxygen. This may be because blood flow to

their brain can be reduced during these reactions (preliminary data from SPECT

brain scans on people with MCS after exposure challenges).

When oxygen is used, it should not be used at a flow rate over 2 liters per

minute (people with lung disease may stop breathing at higher flows and more

flow is usually not necessary). Plastic mask and tubing often aggravate

symptoms: a ceramic mask usually works well, as does Tygon tubing. The tubing

must

be soaked and then repeatedly washed in water containing baking soda, inside

and out (1-2 Tbs. per quart). Mask and tubing are available from the

Environmental Health Center (214-368-4132). A prescription is necessary for

obtaining oxygen and special mask and tubing. Carefully follow ALL precautions

with

oxygen: NEVER use or store in a room with an open flame (cigarette lighters,

cooking stove, sterno heater, etc.).

21. Nutrition

Proteins are needed to properly break down chemicals in the body. Certain

protein " building blocks " or amino acids-such as glycine, glutamine, taurine,

and cysteine-are used in processing chemicals. Deficiencies of various protein

building blocks can interfere with processing certain chemicals.

Deficiencies can occur with increased exposure to certain chemicals _[9]_

(http://www.mcsrr.org/resources/articles/S3.html#9) , and can be aggravated by

problems with

absorption (common in MCS) and vegetarian diets. (Vegetarians may wish to

reconsider animal and seafood protein needs, especially if fatigue is

present).

Mineral, vitamin, and nutrient deficiencies-especially calcium, copper,

iron, magnesium, zinc, and vitamins C, E, B complex, flavin, and

gluathione-also

reduce the body's ability to handle foreign chemicals since these nutrients

are used up in the body's processing of petrochemicals _[9]_

(http://www.mcsrr.org/resources/articles/S3.html#9) . Nutritional evaluation for

nutrient

deficiencies is recommended for MCS patients with persistent chronic fatigue or

with poorer absorption of food (frequent loose stools, frequent undigested food

in stools). Others at increased risk of nutritional deficiencies include:

persons with significant recent exposure to petrochemicals, those with a poorly

balanced diet, those lacking adequate animal (or seafood) protein, and those

with a long history of frequent consumption of processed or " junk " food.

Animal protein such as beef, chicken, pork, mutton, etc. can accumulate

antibiotics, synthetic hormones, and pesticides in the fat (often marbled in

too well

to effectively remove), so try to buy organically raised and range-fed (or

free-range) meat whenever possible.

22. Legal Issues

 

If you are a Chronic Fatigue Syndrome (CFS) sufferer having difficulty with

a disability insurance provider and if your insurer refuses to accept this as

a medical (non psychologic) disability, and you would like to be a part of a

class action suit on this issue (at no cost to you), please mail the

following: Your name, postal address, e-mail address, phone number, the name of

your

insurance company, a brief description of your problem and, if you have it,

a copy of your letter of denial or cancellation from the insurance company.

Send all of this information to:

SPIN (Stop Predatory Insurers Now), c/o Nancy Schilling

CFIDS HEALTH WATCH Newsletter

1167 Coast Village Rd., #1-280

Santa Barbara, CA 93108

Phone: 800-366-6056

 

An MCS group called NOLA-EI (National Organization of Legal Advocates for

the Environmentally Injured) has been tracking insurance and disability

discrimination cases (especially UNUM cases) and trying to organize a class

action

lawsuit. For more information on NOLA-EI and MCS discrimination, contact:

Brenda Harrison

PO Box 29507, Atlanta, GA 30329

Phone: 404-264-4445, Fax: 404-325-2569

 

 

23. Miscellaneous

 

GETTING ANOTHER CAR: If you need to replace your car, it may be best to buy

a used car that has had time to " off gas " chemicals from carpets, plastics,

treated fabrics, undercoatings, etc. Try to get a car from a nonsmoker or

someone with allergies who avoids air fresheners and other chemicals. Used

rental

cars used only for nonsmokers may be a good buy. Ask whether pesticides have

ever been sprayed in the car. Some chemical odors can be removed from

carpeting by using a solution of half AFM Carpet Shampoo and half Mystical

Cleaner

in a water-extraction carpet shampoo machine. An ozone generator may be used

in the car for up to a few hours (longer may damage the interior). The car

should then be aired for a few weeks after the ozone and before use, with

windows open if possible. Never occupy any space treated with ozone before it

has

been thoroughly ventilated. The car dealer may allow you to leave the car on

the lot with windows open after ozone treatment for several weeks.

 

New cars are probably a greater risk. Many leathers are treated with

formaldehyde, which gives that " new leather smell. " Fabrics are coated with

anti-stain treatments ( " new car smell " ). Undercoating treatments may aggravate

symptoms for several weeks or months. Ozone and carpet shampooing can be done

to

reduce exposures as discussed above. Using a car filter device is even more

important with a new or used car. Consider the Allermed model if you do not own

one already.

 

INDEPENDENT MEDICAL EXAMS: If you are required to get an independent medical

evaluation by an insurer or employer physician and are concerned that

spending time in a potentially toxic medical office could aggravate your

illness,

please contact Dr. Ziem's office for assistance.

 

LEGAL ADVICE: Some patients become chemically injured as a consequence of

workplace exposure, some through dangerous or improperly marketed products or

services. Some develop total prolonged disability preventing them from gainful

employment, and some are denied reasonable access to less toxic housing,

workplace, or classrooms. All have legal rights in the United States to:

workers' compensation; redress under product liability precedents; Social

Security

and/or other disability income; and reasonable accommodation under the

Americans with Disabilities Act, respectively. Furthermore, patients may find

that

legal recourse is necessary to secure the necessary environmental controls to

reduce exposures and thus illness effects.

 

However, legal issues are very complex in chronic chemical injury cases. The

lawyer you select must be experienced both with pursuing chemical

injury/sensitivity cases and with the specific legal action(s) appropriate to

the

situation. Even then, new scientific knowledge is rapidly emerging and

attorneys

will need to update their technical understanding on at least a yearly basis.

Dr. Ziem strongly advises that your attorney contact MCS Referral and

Resources (410-889-6666), preferably before filing the claim, obtain and review

all

medical and medical-legal information recommended, and be familiar with

ever-expanding precedents in the recognition of these disorders. Cases with

merit

have been lost because of inadequate preparation or background of the

patient's attorney.

 

TRAIN TRAVEL: If you need to take a train (Amtrak, etc.) And are unable to

persuade them to provide less toxic seating for you (nonsmoking car with no

pesticide spraying in the last 1-2 months, and no odor masking, disinfectant or

air freshener petrochemicals in a rest room), please contact Dr. Ziem's

office for assistance.

24. Getting More Information

 

You may have questions about your environment that come up in between your

appointments with Dr. Ziem. There are groups of chemically sensitive persons

in many states that share information and support. In Maryland, contact Carol

Beauregard, the hotline coordinator of the Chemical Sensitivity Disorders

Association (PO Box 24061, Arbutus MD 21227, 410-792-4875). Like many support

groups, CSDA publishes its own newsletter--The Chemical Sensitivity

Connection--which is available for just $10 per year. To learn about support

groups in

other states, contact any of the national organizations listed below. Also

listed below are national organizations and hot lines that you can contact for

information about particular chemicals and pesticides. For more information on

reducing exposures and finding less toxic alternative products, contact

Carolyn Gorman, the health educator who has counseled thousands of chemically

sensitive persons and the author of Less Toxic Living, at 214-368-4132. For

information on MCS in children and school issues, contact Marian Arminger at

410-247-3953.

 

National MCS Organizations & Publications:

 

Chemical Injury Information Network, P.O. Box 301, White Sulfur Springs, MT

59645; 406-547-2255

Publishes " Our Toxic Times " Membership: Free (donations requested)

Environmental Access Research Network, Route 1, Box 16G, Epping ND 58843;

701-859-6367

Publishes " Environmental Access Profiles " in Our Toxic Times (see above) and

maintains extensive MCS library of over 10,000 medical references.

Environmental Health Network, P.O. Box 1155, Larkspur, CA 94977;

415-331-9804

Publishes " The New Reactor " Membership: $10 to $35

Human Ecology Action League (HEAL), P.O. Box 49126, Atlanta GA 30359;

404-248-1898

Publishes " The Human Ecologist " Membership: $15/year (national organization

with local chapters)

MCS Referral & Resources, 618 Wyndhurst Avenue #2, Baltimore, MD 21210; 410

889-4944, _www.mcsrr.org_ (http://www.mcsrr.org/)

Publishes _ " Recognition of MCS " _

(http://www.mcsrr.org/factsheets/mcsrecog.html) which documents MCS statements

and policies of federal, state and local

government authorities, as well as court rulings and statements of

independent organizations.

Offers _protocol for diagnosis and treatment of chronic carbon monoxide

poisoning_ (http://www.mcsrr.org/CO%20Protocol.pdf) , a common cause of MCS.

National Center for Environmental Health Strategies, 1100 Rural Ave,

Voorhees, NJ 08043; 609-429-5358

Publishes " The Delicate Balance " Membership: $15/year

 

INFORMATION ON CHEMICALS, PESTICIDES AND PRODUCT SAFETY:

 

· EPA Sponsored National Pesticides Telecommunications Network, 800-858-7378

(806-743-3091 in TX)

· Environmental Research Foundation (publishes " Rachel Carson's Hazardous

Waste News " ), 410-263-1584

· National Coalition Against the Misuse of Pesticides, 202-543-5450

· Toxic Substances Control Act Hotline (U.S. EPA), 202-554-1404

· Consumer Product Safety Commission, 800-638-2772

 

25. References

 

1. American Council of Government Industrial Hygienists. 1993-94. Threshold

Limit Values for Chemical Substances, p 2.

2. Ziem, G. and B. Castleman. 1989. " Threshold Limit Values: Historical

perspectives and current practice, " Journal of Occupational Medicine

31:910-918.

 

3. Ziem, G. and B. Castleman. 1988. " Corporate influence on the Threshold

Limit Values, " American Journal of Industrial Medicine 13:531-559.

4. Roach, S.A. And Rappaport, S.M. 1990. " But they are not thresholds: a

critical analysis of the documentation of threshold limit values, " American

Journal of Industrial Medicine 17:727-753.

5. Castleman, B., and G. Ziem. 1989. Guest editorial: " Toxic pollutants,

science and corporate influence, " Archives of Environmental Health 44: p 68.

6. Havey, B., and B. McCreary. Toxic Times Newsletter.

7. Interior Landscape Plants for Indoor Air Pollution Abatement, Sept. 1989,

p. 18.

8. Leiss, J. 1995 " Home Pesticide Use and Childhood Cancer " : American

Journal of Public Health 85: 249-252.

9. Casarett and Doull's Toxicology: The Basic Science of Poisons, Chapter 4

 

[January 1997 edition, updated July 2000]