Multiple Chemical Sensitivity: A Hidden Disability

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Multiple Chemical Sensitivity: A Hidden Disability

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en.html_

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..html)

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(Note: This is my tenth post under the auspices of the _nurse blogger

scholarship_

(http://digitaldoorway.blogspot.com/2008/07/value-care-value-nurses-scholarship.\

html) which I recently received from _Value Care, Value Nurses_

(http://valuecarevaluenurses.org/) .)

 

There is a hidden disability among us, and nurses must become aware of its

existence and champion the cause of so many individuals who suffer in relative

silence and medical neglect.

 

That hidden disability is Multiple Chemical Sensitivity (MCS). This article

will introduce MCS, its symptoms and proposed etiology, and provide resources

for nurses who wish to become more conversant with the vicissitudes of this

very modern illness. As a nurse living with MCS, I see it as my mission to

bring this condition to the awareness of nurses and other medical

professionals, thus increasing knowledge, understanding, compassion, and

available

treatment options for the many sufferers of this much misunderstood and

unacknowledged condition.

 

Multiple Chemical Sensitivity is a chronic health condition afflicting many

people throughout the world. Individuals with MCS report a variety of

symptoms when exposed to varying levels of chemical or fragrance exposure,

including

but not limited to headache/migraine, shortness of breath, confusion,

irritability, dermal erythema/rash, mood changes, anxiety, throat irritation,

dysphagia, bronchospasm, asthma exacerbation, and burning eyes. Standard

diagnostic tests generally do not elicit confirmation of chemical sensitivity,

and MCS

has yet to be officially acknowledged by the American Medical Association as

a physiological illness, relegating this very real condition with very real

physical symptoms to the realm of psychosomatic disorders. Encouragingly, The

Americans with Disabilities Act, Social Security Administration, Department

of Housing and Urban Development, and the Environmental Protection Agency all

recognize MCS as a legitimate disability in need of full accommodation

(Kendall, Katherine. " Accessible Health Care and Chemical Sensitivity " ,

Environmental Health Coalition of Western Massachusetts, 2006, PO Box 187,

Northampton,

MA, 01061.)

 

Since World War II, thousands of unregulated chemicals have been introduced

into our environment. Through the mediums of household conveniences, modern

packaging, air fresheners, cleaning agents, and a multitude of hair and

personal care products, many chemicals which are known carcinogens (and often

banned in other Western countries) are applied daily to the skin of unknowing

individuals, aerosolized into the air we breathe, or even transmitted through

breast milk or across the placenta to our children's growing bodies. An

astronomical number of chemicals with known neurotoxic effects are used to

produce a

plethora of personal care products, and due to lack of regulation to protect

proprietary trade secrets, citizens' health is regularly compromised.

 

A growing body of literature is continuing to document the physiological

effects of chemicals on multiple human organ systems. _A 2006 study_

(http://www.sanepr.com/Studies-Show-Air-Fresheners-May-be-Harmful_14606.cfm) by

the

University of Colorado and and Baylor College of Medicine in Houston clearly

drew

conclusions linking chemicals in commercially available air fresheners to the

formation of cancerous cells. _Another study by Anderson Laboratories in

Vermont_ (http://www.free-press-release.com/news/200703/1174980567.html) showed

a direct correlation between exposure to commercial perfumes and acute

neurotoxicity and air flow reduction in mice. Additionally, a _German study_

(http://web.archive.org/web/20070928063707/http://www.ehjournal.net/content/6/1/\

6)

found a potential genetic link vis-a-vis sensitivity to chemicals in the

form of L-Glutathione, a endogenous hepatic chemical important for the

detoxification of exogenous chemicals and irritants.

 

While some workplaces have begun to initiate " fragrance-free " policies to

protect workers and clients alike, even the real estate industry is beginning

to notice the _economic impact_

(http://web.archive.org/web/20080122140035/www.free-press-release.com/news/20070\

3/1175069176.html) that chemical exposure

can have on prospective home buyers. The _Investor Environmental Health

Network_ (http://iehn.org/home.php) also recognizes the economic risk posed by

chemical contaminants in products and homes, with reports of shareholders

withdrawing support for investments in companies whose products contain

ingredients

known to be harmful to human health, as well as those ingredients which have

never been tested for human toxicity. An _informative video_

(http://www.youtube.com/swf/l.swf?swf=http://s.ytimg.com/yt/swf/cps-vfl59689.swf\

& video_id=11JvM

ZoMY8g & rel=1 & hqt=1 & eurl=http://iehn.org/multimedia.online.php & iurl=http://i2.y

timg.com/vi/11JvMZoMY8g/default.jpg & t=OEgsToPDskKwYLg03AvmA7omB9g68_6b & use_get

_video_info=1 & load_modules=1)

(http://www.youtube.com/swf/l.swf?swf=http://s.ytimg.com/yt/swf/cps-vfl59689.swf\

& video_id=11JvMZoMY8g & rel=1 & hqt=1 & eurl=http:

//iehn.org/multimedia.online.php & iurl=http://i2.ytimg.com/vi/11JvMZoMY8g/defau

lt.jpg & t=OEgsToPDskKwYLg03AvmA7omB9g68_6b & use_get_video_info=1 & load_modules=1)

on their website details the issue.

 

In 2006, Bill Moyers aired _a PBS special_

(http://web.archive.org/web/20071017111403/www.pbs.org/tradesecrets/problem/prob\

lem.html) highlighting the

deleterious effects of chemicals on human physiology, exposing the nefarious and

cynical lack of government and regulatory oversight of the chemical industry

in the interest of trade secrets. His investigative journalism uncovered

scientific proof that children---especially children still in utero---are

exposed

to enormous concentrations of neurotoxins during critical periods of

neurological development. During the course of his investigation, Mr. Moyers'

hair

was tested for the presence of various heavy metals and neurotoxins, and the

results were staggering, with dozens of toxic chemicals present in his

bloodstream. Recent scientific findings have led to ongoing research to

discover if

the " epidemic " of ADD, ADHD and even Autism may be linked to the explosion of

unregulated chemicals saturating our environment since World War II. Moyers

points out that political contributions by the chemical industry to both

major political parties over the decades have bought a great deal of freedom

from

oversight for the purveyors of such substances, and the only party injured

by that sweetheart deal has been the blissfully ignorant American people.

 

In terms of attention from healthcare professionals, this writer has been

most heartened by an article_ in the American Journal of Nursing_

(http://web.archive.org/web/20070818224949/www.nursingcenter.com/library/Journal\

Article.asp?

Article_ID=698036) (Cooper, Carolyn. " Multiple Chemical Sensitivity in the

Clinical Setting " , AJN, March 2007, Volume 107, Number 3, pp. 40-47). The

author, Carolyn Cooper, presents a thoughtful and relatively comprehensive

article, outlining the potential etiology of MCS, general symptomatology,

demographics, as well as the controversy surrounding the struggle for

recognition of

MCS as a physiological condition. To her credit, Ms. Cooper uses a case

study, complete with photographs and a patient's true identity, to illustrate

the

special considerations and accomodations necessary for a hospitalized

patient with MCS. I was both impressed and gratified that Ms. Cooper took her

patient's needs at face value, working closely with his wife to manage his care

without exacerbating his condition, providing optimal care for a patient at his

most vulnerable, and taking the time to educate her colleagues as part of

the process. Ms. Cooper then provides a thoughtful and step-by-step list of

instructions and recommendations for accomodating patients' dietary and

environmental needs while hospitalized. This is truly a must-read for every

nurse.

 

Due to the prevalence of respiratory diseases such as COPD, asthma, and

environmental allergies, all healthcare facilities should consider enacting

strict fragrance-free policies for both visitors and staff. Individuals with

MCS

are often socially isolated due to the risk of chemical exposure in both

public and private spaces. Sadly, individuals with MCS often feel at great risk

when entering a healthcare facility, even for the most basic of preventive

healthcare. With potential sensitivities to ammonia, bleach, latex, chemical

cleaning products, fragranced soaps and hand sanitizers, colognes worn by staff

and other visitors, as well as the ubiquitous second-hand cigarette smoke

lingering around the entrances to public buildings, a visit to a healthcare

facility can be an exercise in anxiety and damage control for the person with

MCS.

We all know that a hospital stay for a non-chemically sensitive individual

can be stressful and far from restful. With MCS on board, a hospital stay can

indeed feel potentially lethal to the patient with MCS.

 

When considering the controversy over the medical validity of MCS, please

recall the uphill battles for recognition waged vis-a-vis

Fibromyalgia/Myofascial Pain Syndrome, Restless Legs Syndrome, and Chronic

Fatigue Syndrome. Many

diseases begin their careers as second-class illnesses discarded on the

psychosomatic scrap heap. I would venture a guess that even Borderline

Personality

Disorder and Post-Traumatic Stress Disorder saw their share of nay-sayers

back in the day. While rigorous scientific validation is indeed useful when a

new disease is barking at the door of the AMA, it appears that politics,

economic interests and entrenched ways of thinking can often stand in the way

of

progress. The insurance lobby certainly has a vested (financial) interest in

keeping MCS out of the ICD-9 code-book, and those chemical companies must be

plenty worried as investors withdraw funding from their products due to fear

of litigation and reprisal for deleterious health effects. Politics and

healthcare make strange bedfellows, but one must not forget that managed care

and

the insurance lobby also have economic interests at heart, and I would not be

surprised if some of those economic interests could be traced to decision

makers high within the echelons of the venerable AMA. What a tangled web we

weave.

 

As nurses, beyond the politics, the insurance tangles, and the economic

vicissitudes of healthcare, we are faced with patients who entrust us with

their

lives and well-being. When a patient enters your unit and informs you that he

or she has Multiple Chemical Sensitivity, what are you to do? How will you

approach other staff members? How will you even begin to accommodate your

patient and assuage his or her concerns? With all of the normal stressors of

your

workload, how will you make the time to accommodate such specific needs? The

answer is education and information, and when that patient walks through

your door, that education will be a steep learning curve indeed for the

ill-prepared. Listening to your patient and taking his or her concerns at face

value

is a good place to start. The article mentioned above in the American Journal

of Nursing is another valuable resource. _MCS-America_

(http://web.archive.org/web/20071130044217/www.mcs-america.org/) offers

resources and links, as

does _MCS Resources and Referrals_

(http://web.archive.org/web/20071010091829/www.mcsrr.org/) . Governmental

websites---like_ OSHA_

(http://web.archive.org/web/20071031042311/www.osha.gov/SLTC/multiplechemicalsen\

sitivities/index.html)

and _The Interagency Workgroup on Multiple Chemical Sensitivity_

(http://web.archive.org/web/20070923040926/www.health.gov/environment/mcs/index.\

htm)

---offer some additional guidance.

 

As professionals who want to provide the best care possible for every

patient, it behooves us to prepare in advance for as many eventualities as we

can.

As latex allergies have come to the fore, awareness has increased as

facilities begin to provide staff education (and proper accommodations) for

patients

and staff with such sensitivities.

 

If your facility has indeed addressed latex allergies (which this writer

hopes they have), perhaps the administration will be open to discussions

regarding MCS if the request is framed in light of the exponential explosion of

latex sensitivity (and perhaps peanut allergies) across the population. Making

a

link between latex allergies (which worsen with continued exposure) and MCS

(which also worsens with each exposure) will help administrators and managers

understand and integrate the importance of the issue. As peanut and latex

allergies have gained acceptance, recognition, and action throughout the

country, those suffering such sensitivities have felt increasingly emboldened

to

demand accommodation and safety. It cannot be denied that unregulated and

dangerous chemicals permeate our environment, homes, schools, and hospitals.

Shouldn't those sensitive to, and made ill by, such products also be given our

attention and support?

 

Nurses are not just caregivers. We are advocates. We do not just treat

patient's symptoms. Nurses look at the whole person, sometimes called a

" biopsychosocial " approach to care. Apropos of this fact, this writer contends

that

nurses must take up the cause of vulnerable populations within the healthcare

setting. When we think of vulnerable populations, what generally comes to mind

are the homeless, the uninsured, the underinsured, children, the elderly.

Moving beyond that more narrow definition of vulnerability, we must also

embrace

the " silently vulnerable " , those whose disability is less apparent, and

perhaps, as is the case with MCS, resolutely rejected by the medical

establishment.

 

Chemicals and chemical sensitivity are not going away, no matter how the

AMA, the insurance industry, and the chemical industry hope that they will

simply fade into the background. The MCS community is lobbying hard to win

recognition and validity. This writer calls on nurses everywhere to take up the

gauntlet of MCS and bring it to the attention of your coworkers and

administrators. Our voice can be heard loud and clear. Let's be the megaphone

for a

condition whose time has come.

 

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