Dr. Sarah Myhill
When I first started treating patients with CFS, the cause was either viral or “I don’t know”. I now realize that many of the “I don’t knows” were cases of poisoning either from organophosphates, silicone, carbon monoxide, sick building syndrome (formaldehyde, volatile organic compounds etc) and so on. Furthermore, I now suspect that many of those patients with post viral CFS actually were poisoned by some chemical which weakened the immune system so that it was unable to cope adequately with a subsequent viral infection.
The sort of problems I have seen are: CFS following sheep dipping, spraying agricultural chemicals, being sprayed by tractor or helicopter and spray drift, working in a chicken farm (fumigation, control of parasites), repeated head lice treatments, house fumigations for flea control or bed bugs, insect control in hot countries with DDT, OPs etc, control of sand flies (Gulf War Syndrome), greenhouse fumigations, working in a research plant center where chemicals were weekly used to prevent cross contamination, student doing a biology project with pesticides, carpet factory where fleeces are washed after sheep have been dipped, lorry driver delivering OPs to farmers, welders working in a factory which was manufacturing OPs, timber treatments in houses, treatment of external parasites in dogs, cats, cows (OP pour ons) and so on. There are many other occupations where people are exposed to chemicals, but incidents are often forgotten.
With silicone I am not just looking for the obvious breast implant or silicone injections, but many other prostheses have biologically active materials. Examples include testicular implants, lens implants, Norplant contraceptive device (silicone rods), TMJ work, facial contouring, meshes for hernia repairs etc. In the veterinary world reactions to suture materials are well documented – not so in the medical world.
With carbon monoxide poisoning I am looking for evidence of illness following a house move, new (or very old) central heating, condensation suggesting blocked chimneys, free standing gas fires which do not vent to the outside, odd smells etc.
I always ask about occupational history – chemicals in the work place such as building projects, poultry and egg rearing, manufacturing industry, paints, new carpets, flower industry (lots of chemicals on flowers), printing industry, “sick building syndrome” and so on.
These patients present with chronic fatigue syndrome and it is largely this that prevents them from working.
However these chemicals are extremely toxic to other parts of the body and may also cause:
Damage to nerves – Central nervous system (psychological problems, psychiatric, sleep, brain fog etc) autonomic nervous system (sweating, temperature control, hyperventilation, etc) and peripheral nervous system (numbness, tingling etc).
Damage to bones – osteoporosis, abnormal bone biopsies, abnormal bone metabolism
Damage to the immune system – allergies, autoimmune disorders and multiple chemical sensitivity (and of course CFS). Tests often show immune damage.
Damage to the heart – particularly the electrical conduction system producing arrhythmias
Damage to the endocrine system – abnormalities of the hypothalamic-pituitary-adrenal axis, thyroid damage, sex hormones
Probable damage to the liver
These chemicals are also carcinogenic, teratogenic (damage to the unborn baby), and damage sperm causing low sperm counts and infertility.
Symptoms of Organophosphate Poisoning
Organophosphates (Ops) are extremely toxic chemicals used in farming practice in sub-lethal doses. Every bodily system can be adversely affected by OPs, therefore sufferers present with a multiplicity of symptoms. Any one of these symptoms can be ignored or coped with. It is when they come together and are so persistent, that sufferers present to their doctors.
When patients come, they will not arrive with a list of all their symptoms. Sufferers will only tell you about the symptoms, which they believe might be serious. Many sufferers present with chest pain or headaches suspecting heart problems or a brain tumor. They have to be asked specifically for details of other symptoms, or the diagnosis will be missed.
Past Medical History: usually there is no serious illness in the past. However when asked, many sufferers will give a history of sheep dippers ‘flu. After dipping sheep they often have an illness which lasts a few days during which they feel completely wiped out, ill, ‘flu like, often with headaches or muscle aches, sometimes chest pains and nausea. This is often forgotten because it just lasts a day or two. Some sufferers get neurological symptoms such as cramps, weakness of muscles, numbness and tingling and loss of balance for a few days to a week or two after dipping (so called intermediate syndrome), but this is often forgotten and the relationship to dipping unnoticed.
Current Symptoms: The “core symptoms” of OP poisoning – most sufferers have these to a certain extent.
Severe, debilitating fatigue which is physical and mental.
- physical – no stamina, loss of muscular strength (episodic blurred vision), sudden “hitting a wall”, has to rest regularly and pace all activity
- mental – poor short term memory, unable to learn new things, poor concentration, speech difficulty with poor work finding. Long term memory usually fine.
Malaise – sufferers feel ill, “hung over”, “poisoned”.
Muscle aching – often widespread, flitting from one group of muscles or joints to another, often requiring painkillers.
Drug intolerance (such as alcohol, antidepressants)
Change of personality
Multiple chemical sensitivity. Sufferers
a) become more sensitive to OPs, which means that they get bigger reactions with smaller doses.
b) become sensitive to other chemicals. This is called a "spreading phenomenon" and classically these people start to react to many other chemicals such as diesel fumes, perfumes, cigarette smoke, alcohol and so on.
c) Develop an exquisite sense of smell – they can smell chemicals long before
anybody else – they are true “canaries”
Other symptoms also suffered such as:
Shortness of breath
Muscle twitching or cramp
Irritable bowel syndrome (abdominal pain, bloating, diarrhea/constipation etc)
Poor balance and dizzy spells
Numb patches, clumsiness
Mood swings, irritability, impulsive suicidal thoughts
Tendency to pick up infections
Many other symptoms
OPs get into the body, cause damage and are then excreted. Unless one is within a few days of exposure, it is pointless doing tests to measure OP levels or cholinesterase levels. Tests are aimed at looking for damage to the body. The damage to the body is widespread and subtle – sensitive tests have to be done, many of which are not routinely available. So many sufferers get the standard “work up” of tests, which are either inappropriate, or minor abnormalities overlooked. For example:
Full blood count – usually normal – there may be a low white cell count
Urea and electrolytes – usually normal
Liver function tests – usually normal. There may be slightly raised liver enzymes (Often ignored) or a slightly raised bilirubin suggesting Gilbert’s syndrome.
Hormone tests – usually interpreted as normal
X-rays – all normal
ECGs – usually normal
Nerve conduction studies – of the motor and sensory nerves – usually normal. Abnormalities may be found if tests are done within 2 years of the most recent exposure to OPs.
MRI scan of the brain - normal
Most OP sufferers get this standard battery of tests and are told there is nothing wrong with them. However there are abnormalities which would be picked up by the following tests:
Immune abnormalities – most of these are research only tests, but if available look for low levels of natural killer cells, low levels of B cells, abnormal T suppressor/helper lymphocyte ratios, raised C reactive protein and hypogammaglobulinaemia. ANCA, TNF and interleukin 6 may also be abnormal.
Liver function tests – sensitive tests of liver function (including glutathione S transferase, 5 nucleotidase, RBC glutathione, urinary D glucaric acid), and tests of the liver’s ability to detoxify (caffeine, paracetamol loading) – often abnormal.
Hormonal studies suggest a suppression of the pituitary gland with borderline underactivity of the thyroid (TSH, T4 and T3), mild Addison’s disease (adrenal stress index test – salivary cortisol and DHEA over 24 hours), inappropriate ADH secretion, poor melatonin levels resulting in sleep problems, low levels of sex hormones etc. The thyroid abnormality is interesting classically with low TSH and low T4 (in the lowest 20% of the “normal” range. Thyroxine can be very helpful.
Osteoporosis – bone density scan at the wrist, hip and spine is mandatory. Often abnormal urinary metabolites indicating faulty bone metabolism namely deoxypyridinoline (Dpd) and N-telopeptides (NTx).
Psychometric testing – shows severe impairment of memory, information processing, learning, concentration etc. This is not easy to get on the NHS but should be demanded – available via consultant neurologists. It gives sufferers “street credibility” and helps with getting disability allowances.
Nerve conduction studies of the autonomic nervous system – presently only done by Drs Jamal and Julu,. The autonomic nervous system controls automatic functions such as temperature, sweating, blood pressure, heart and respiratory rate, gut function etc. Abnormalities are commonly found in OP poisoned sufferers and are persistent.
Brain scans to demonstrate function (such as SPECT scanning) show poor perfusion of particular areas of the brain. Most of this work has been done on Gulf War veterans.
Trace elements levels – often deficiencies of magnesium and selenium
Vitamin deficiencies – particularly of the B vitamins – in fact this is so common that I do not bother to do tests, but use multivitamins routinely.
Antibodies to brain proteins (cytoskeletal antibodies) sometimes raised (test not available in UK).
Conduction abnormalities in the heart – arrange 24 hour ECG monitoring for symptoms such as chest pain or palpitations.
Allergy testing – OPs are immune adjuvants and “turn on” allergies. Objective tests for allergies are unreliable therefore elimination dieting has to be undertaken.
OPs disrupt the immune system. There may be an increase in auto-immune disorders and auto-antibody screening may pick up abnormalities. I have seen OP poisoned farmers with multiple sclerosis, scleroderma, positive anticardiolipin antibodies, CREST syndrome, Churg Strauss syndrome.
Visual field abnormalities – most opticians can map visual fields – sometimes holes can be found.
Other neurological diseases such as Parkinson’s are thought to be OP related. Some schools of thought believe prion disorders such as BSE/CJD may also be related to OP exposure.
Increased cancer risk in the long term.