By Robert Anderson MD, ABIHM Executive Director
Tom came to me as the seventh physician whom he had seen in two and one-half years. At 31, he had first seen his family doctor for attacks of anxiety, pounding heart, shortness of breath and sweating. These symptoms were unrelated to meals or any other consistent exposure that anyone had figured out. He was treated with Xanax (a tranquilizer like valium) with partial relief of symptoms. He was referred to an internal medicine specialist who found a normal blood sugar and diagnosed his condition as “panic attacks.” Tom was treated with a beta-blocker (a drug like Inderal to slow down the fast heart rate which accompanies panic attacks). This did not relieve his anxiety, fidgeting and restlessness. He saw an endocrinologist who concluded after numerous tests that his thyroid was functioning normally and suggested that he might wish to see a psychiatrist. During this time he grew steadily worse and found it difficult to finish a complete week of work at his job in a machine shop located on the waterfront in Seattle. After being on the beta-blocker for some time, he began to have a distinctly diminished sex drive and poor quality erections, a known side effect of beta blockers.
Through several months of psychotherapy, he continued to grow worse and increased his dose of Xanax to the highest levels suggested in the Physician’s Desk Reference. He had seen a Chiropractor and later an Acupuncturist before coming to see me.
I carefully combed his history for any clues his previous physicians might have missed. Responding to my meticulous questioning, Tom volunteered the curious observation that he never had any of his panic spells on Saturday afternoon or evening, Sunday morning or evening, or Monday morning. He also related growing steadily worse as the week progressed, with Friday always being by far his worst day. By Saturday afternoon he always had begun to feel better! Further, he had improved during each of his last three one-week vacations, which he attributed to being away from the stress of work and heavy highway traffic. Perhaps he was having a problem related to his work ? handling stress poorly, or perhaps he was reacting to something in his environment. He described being consistently exposed to a variety of chemical fumes. He had begun his job in the machine shop about three months before his panic spells began. His initial responsibilities on the job included clean-up in which he used a variety of cleaning materials and solvents in various areas of the shop.
I asked him to follow a protocol which I put in writing. He was to try to arrive early at work in time to check and record his pulse after sitting quietly in his truck for ten minutes before clocking in. I asked him to also take his pulse on leaving work after he had been sitting quietly in his truck for ten minutes without activity or listening to the radio. He followed the suggestions and kept a written record of his pulses morning and evening.
For each of the first two weeks of his records, his morning pulse rose steadily from sixty on Mondays to eighty-five on Fridays; the afternoon pulse rose from 75 on Mondays to 105 on Friday. After the second week of these results I persuaded him that he needed time away from work. He had scarcely any accumulated sick leave or accrued vacation. He filed a claim with the state Department of Labor and Industries for injury on the job. As part of his treatment I recommended a leave-of-absence. The problems of his rejected claim with state industrial insurance constitute another whole story.
Blood specimens were submitted to a toxicology laboratory in Texas to attempt to identify the chemicals to which he seemed to react, but the results were equivocal and not definitive. Over a six week unpaid leave from work he improved steadily and his beta-blocker drug was tapered and eliminated. His Xanax had to be reduced very slowly to avoid the emergence of bothersome and serious symptoms of withdrawal. It was very likely he had become habituated to it. With the addition of biofeedback, relaxation training and several cognitive-centered counseling sessions, he ceased having all panic spells and decided not to return to his old job.
Was his problem stress? Six weeks with no work or pay and a search for a new job without chemical exposures were certainly stressful enough. He continued to steadily improve during this time, and it appeared that his symptoms were related to exposure to solvent chemicals to which he had become sensitive. His freedom from panic spells led me to believe this was an environmental sensitivity and not stress related.
It was quintessential that someone spend enough time with him to provide the space in which he could report what he had observed about the pattern of his symptoms. As the saying goes, “the devil is in the details.” In his case, the answer was in the miniscule details.
In our modern era of “Better Living Through Chemistry,” thousands of chemicals have been introduced into industrialized countries. It is important to remember that most of our “first world” degenerative diseases – coronary heart disease, cancer, diabetes, brain deterioration, etc. – are extremely rare or completely unknown in ‘primitive’ indigenous societies. Historical studies have confirmed the arrival of many of these degenerative diseases in “primitive” cultures only a few years after introduction of our “Western” lifestyle including our chemicals.
These chemicals lace our food, pollute our air and saturate our water supplies. Newspaper headlines often announce a scientific study which has revealed a new chemical offender which makes people ill or causes death. Lead is found in toys from China. Chlorination of water benefits us by killing most potentially harmful germs, but combines with organic residues to form organohalides which induce a higher level of bladder and rectal cancer in those who consume chlorinated water.
The field of environmental medicine grows increasingly more complex as our chemical environment multiplies the incidence of human reactions to chemical agents. Using filters for cooking and drinking water is a helpful initiative, and consuming organic food sources within a few days reduces the load of pesticides and herbicides found in the body.