I was a healthy 43 year old working in a hospital and had to take a leave of absence summer of 1998 due to orthopedic injuries to get physical therapy and to let the injuries heal. While I was gone on leave the hospital had purchased new floor cleaning and finishing equipment. When I returned to work in September of 1998 it seemed that the hospital was using the new equipment excessively outside my office. I was exposed to the fumes from the products used to clean, strip and polish floors as well as to particles emitted by the floor burnisher. In February of 1999 I developed severe migraine headaches. Within a month I developed allergic reactions to chemicals including fragrances, cleaning chemicals, ink, formaldehyde in particle board, gasoline, oil (had leak in older model car), pesticides as well as to airborne allergens mold, dust and pollen. My symptoms included headaches, skin rashes, lung congestion, chest tightness, gastrointestinal symptoms, blurred vision, fatigue and difficulty concentrating.
I continued to work despite these symptoms until June of 1999 when the hospital started a construction project. The dust from construction caused a worsening of the lung congestion, shortness of breath, severe nausea. weight loss and heart palpitations and I was forced to leave work.
In June of 1999 I was seen by a toxicologist who diagnosed reactive airway dysfunction syndrome (RADS) and chemical sensitivity due to exposure to workplace chemicals. In January of 2000 I was seen for first time by an environmental medicine physician, a member of the American Academy of Environmental Medicine (AAEM). He diagnosed me with reactive systemic disease due to exposure to floor stripper and burnishing by-products manifesting RADS, reactive intestinal dysfunction syndrome (RIDS), chemical sensitivity, etc. and provided treatment including an extensive program of biodetoxification.
In March of 2002 I had an extensive neurocognitive evaluation which showed neurocognitive deficits with memory, attention, constructional dyspraxia, left right confusion, eye tracing and scanning impairment, etc. which the neuropsychologist said were consistent with a solvent injury and that there was no other explanation for them other than the workplace chemicals.
After leaving work June of 1999 the pulmonary symptoms continued for a couple of months then resolved. In August of 1999 I had a worsening of gastrointestinal symptoms as developed severe abdominal pain and bloating, constipation, etc. This continued for four months when finally (after having been to numerous doctors) I had a Comprehensive Digestive Stool Analysis (CDSA) that showed multiple GI abnormalities including an intestinal infection. In December of 1999 I was prescribed three weeks of antibiotics which greatly improved the abdominal pain. Later I was tested and found to have multiple food allergies.
Now over twenty years later I continue to have chemical/environmental sensitivities, gastrointestinal issues and neurocognitive impairment. All these years I have been followed by the same environmental medicine physician or his partner. Have also been followed by the same neuropsychologist and in 2012 had extensive followup testing. My main treatments for the chemical/environmental sensitivities have always been avoidance of environmental toxins and use of sauna to help eliminate toxins.
Perhaps everyone does not know that the job of Workers’ Compensation (WC) is to argue against claims for benefits. And in fact, my WC claim was rejected as they claimed I was not injured. However I got social security disability which acknowledged that I was injured by workplace chemicals and as a result had become physically disabled and that it was a permanent disability. Unfortunately to make the case to deny my WC claim for benefits, the WC Decision is riddled with inaccuracies. So I’ve written the following rebuttal for my website to set the record straight.
The newly chemically injured face an uphill battle to get medical help from mainstream medical practitioners. Most physicians are not trained in the recognition or treatment of chemical injury and sensitivity. Dr Ann McCampbell, a leading expert in environmental health and multiple chemical sensitivity (MCS) writes the following:
“Chemically sensitive people are advised to find a physician who is knowledgeable about MCS, in order to avoid getting sick in standard medical offices, being misdiagnosed, put through inappropriate or hazardous testing and treatment, and suffering from disbelief or even hostility from the medical staff. Many medical doctors who specialize in the evaluation and treatment of MCS can be located through the American Academy of Environmental Medicine, http://www.aaemonline.org “.
Unfortunately I experienced the disbelief and misdiagnoses that Dr McCampbell refers to. For example, the first doctor I told that I had become sensitive to fragrances rolled his eyes (remember this is over twenty years ago). Another doctor wanted to test me by putting me into a chamber and instilling various chemicals to see my reactions! And a couple of doctors wrote off my chemical sensitivity and GI symptoms to somatization or psychological problems. This is why I saw so many doctors the year I got injured as it only took one or two visits for me to realize they were not trained in diagnosing or treating a chemical injury and I would move on and try another one. I finally learned of AAEM physicians and and that I was going to have to go out of state to see an AAEM physician (there were none in state at the time) in order to get treatment.
Besides documenting neurotoxicity the neuropsycholgical testing that I had in 2002, two years after my injury, showed absolutely no evidence of malingering and that I was emotionally healthy and free of psychopathology. During the year I was injured however I did suffer from anxiety and depression due to the severity of ill health, neurotoxicity from the chemical injury and because of the difficulty in finding medical help. The neuropsychological evaluation did not get entered into evidence in time to meet the deadline for admission into evidence as I had no idea there were deadlines for submitting evidence. Months ahead of the hearing I had contacted my lawyer informing her that I was going to be undergoing this extensive neruopsych testing but she never responded to either my voicemails or my letter informing her. As a result I never learned about any deadlines for admission into evidence. To her credit my WC lawyer argued at the hearing and later for the appeal that the neuropsych eval should be allowed into evidence to combat charges by WC that my chemical sensitivity symptoms and GI symptoms were psychological. But the WC judge would not allow it into evidence nor later would the judge for the Appeal. Besides disproving the psych charges this neuropsych evaluation was strong evidence for my WC claim as it showed neurocognitive damage that could only be explained by the workplace chemicals.
Anyway the point of all this being the negative WC Decision needs to be taken with a huge grain of salt. The judge decided not to go with my treating physician and our other experts all who had a great deal of expertise in the recognition and treatment of chemical injury and sensitivity. Neither of the two physicians the judge cited the most and apparently sided with were experts in the field of toxic injury. Nor did either one actually see me or were my treating physicians. And there opinions were very inaccurate. In fact I couldn’t find a single accurate statement by either physician in their opinions. Also they were enlisted at the last minute by the other side for their opinions so this gave our side no ability to counter them with evidence of our own according to my work comp attorney.
Here are the two sides’s experts for comparison of their credentials and main findings:
Our medical experts:
-Local toxicologist, diagnosed reactive airway dysfunction syndrome (RADS) and chemical sensitivity from exposure to workplace chemicals.
–Environmental Medicine Physician, my treating physician, from South Carolina. He is a Fellow of the AAEM (highest status one can attain in the practice of Environmental Medicine) and diagnosed me with reactive systemic disease including RADS, reactive intestinal dysfunction syndrome (RIDS), chemical sensitivity, etc. from exposure to floor stripper and burnishing by-products (ethanolamine, xylene, alcohols and caustics). Results of lab tests he ordered where consistent with exposures to toxic chemicals including an activated immune profile, borderline low white blood counts suggesting bone marrow suppression and a DSMA challenge showing moderate amounts of metals, arsenic, cadmium, mercy and nickel. (Heavy metals increase risk for developing chemical sensitivity).
–International Environmental Diagnostics Inc. where a team of scientists independently examined my medical records and Material Safety Data Sheets for a private disability policy. They felt strongly I had developed chemical sensitivity due to an acute exposure to the analyzed chemicals used to strip, clean and polish floors. They said the symptoms I displayed and my exposure to volatile organic compounds (2-butoxyethanol, dipropylene glycol, acrylic compounds and diethylene glycol) fit into two general types of exposures capable to initiate chemical sensitivity: 1) massive, overwhelming exposure or 2) repeated, low-level exposure. Source: N. Ashford & C. Miller: “Chemical Exposure, Low Levels and High States”.
Note: The WC judge in the appeal stated “the theory of permanent injury resulting from such a minimal exposure is tenuous a best”. But according to Raymond Singer and Dana Darby Johnson in “Recognizing Neurotoxicity” “Chronic exposure to low levels of some toxic chemicals can be even worse than a single acute exposure, because brain damage is cumulative over time”. http://neurotox.com/project/recognizing-neurotoxicity/
–Integrative Medicine Physician from New York City also independently reviewed medical records for the same disability claim and said medical data clearly supported diagnosis of chemical sensitivity related to exposure to workplace chemicals. Stated that my respiratory and systemic symptoms with subsequent development of “irritable bowel” symptoms were consistent with diagnoses of chemical sensitivity, RADS and RIDS. Said that physicians unfamiliar with chemical sensitivity failed to recognize the diagnoses. Stated only the toxicologist and environmental medicine physician accurately recognized diagnoses and gave appropriate treatment. Said that environmental tests done by the hospital were irrelevant: there was not testing for toxic chemical residues, hydrocarbons, volatile organic compounds, etc.
The work comp’s medical experts:
-The local physicians the other side listed as their experts and were mentioned in the Decision I saw only once or twice. I saw them only once or twice because they were not trained in the recognition and treatment of chemical injury and sensitivity so were unable to provide accurate diagnoses and treatment. However one physician I very much appreciated was the physician who in December 1999 prescribed the antibiotics which greatly improved the severe abdominal pain I’d had for four months.
The following two physicians were enlisted for their opinion by the other side and their opinions admitted on last day of the deadline for admission into evidence prior to WC hearing:
–Occupational Medicine Physician from Springfield, MO in his opinion said only if I ingested floor cleaning solution or it came into direct contact would the floor cleaner cause irritation which he stated in his full report (where the heck did he go to school!). He made no mention anywhere in his report, that I could find, that volatile organic compounds (VOCs) or the inhalation of floor burnisher residue could cause harm. Said that following my injury I continued to note the same GI symptoms that I’d had prior to my injury. Yes, I did have history of gastritis due to long term use of NSAIDS for orthopedic injuries. I finally got off the NSAIDS in 1998 following physical therapy and chiropractic treatment. He said I was diagnosed only with irritable bowel following the injury. Yes I was diagnosed with irritable bowel but this was before I got the CDSA test that showed significant abnormalities including results consistent with an intestinal infection. Somehow the record of this diagnostic GI test was not included in my work comp case whereas it was for Social Security. And yes I also had a history of a deviated septum, allergic rhinitis and sinusitis prior to the injury. According to Raymond Singer and Dana Darby Johnson in “Recognizing Neurotoxicity” the chemically injured often have preexisting conditions. “It makes sense that people whose health is already compromised are the most vulnerable to poisons, because their bodies’ detoxification systems—especially the liver and kidneys—are already stressed. People with a preexisting condition suffer further deterioration of their health. http://neurotox.com/project/recognizing-neurotoxicity/
The enlisted occupational medicine physician also stated that I did not meet the criteria for my environmental medicine doctor’s diagnosis of Reactive Intestinal Dysfunction Syndrome (RIDS). This is actually laughable as my environmental medicine physician is the author of a medical journal article on RIDS! If anyone would know whether I meet the criteria for RIDS it would be him! Here are two excerpts from his article entitled “Reactive Intestinal Dysfunction Syndrome (RIDS) Caused by Chemical Exposures”:
“In this article, we describe eight patients who presented with acute onset of abdominal distress characterized by severe bloating or edema of the abdomen. Other systemic signs and symptoms occurred, but the intensity and severity of the gastrointestinal distress was so marked that they clearly suggested a recognizable pattern or syndrome.” Well this sounds exactly what happened to me ie the solvent exposure damaged my GI tract and then medications worsened my gastrointestinal symptoms including one medication that sent me to the ER for acute onset of nausea, abdominal pain and distension.
The article also states: “A possible explanation for a combined immunologic and nonimmunologic mechanism may be that of neurogenic switching, a hypothesis offered by Meggs (16) (i.e., stimulation of inflammation at one site can lead to inflammation at another site). Inasmuch as almost all of our cases were triggered via the respiratory tract, neurogenic switching might explain the subsequent triggering of the gastrointestinal tract as an alternative site. ” Again this sounds exactly what happened to me. The target organ for my chemical injury was initially the respiratory tract. That resolved several months after leaving work but then I developed severe abdominal pain, bloating, gas and constipation.
-Local Pulmonary Physician said there was no identification of exactly what chemicals caused my problem and no lab work performed by my environmental doctor, also that there was no objective evidence of injury from chemicals. Apparently he did not get all of my environmental medicine doctor’s records as even the Decision cites several records by my doctor that clearly address all of these things. The pulmonologist also discounted the existence of multiple chemical sensitivity. He didn’t recognize that chemical sensitivity is a real condition that can result from a chemical injury. So it’s not surprising he kept going the psych route if he didn’t even believe the condition exists. Also, said I had seen multiple doctors for abdominal complaints and no physiologic cause was identified. Remember this was 20 years ago when irritable bowel was not considered to have a physiologic cause by many docs at the time. Also, as previously stated I did eventually have the diagnostic GI test, i.e.the CDSA, that clearly showed physiologic causes, i.e. multiple abnormalities including results consistent with an intestinal infection. I was prescribed a three week course of antibiotics which greatly improved the abdominal pain. He apparently did not get these records either.
According to the pulmonary doctor the other side enlisted for his opinion I’d apparently never had a real medical condition pretty much my whole adult life! This is totally ridiculous as my medical conditions have all had physiologic causes. I suspect the other side’s enlisted doctor was once again given incomplete records. He obviously did not get my ENT, physical therapy, chiropractor, gynecology records which is where you primarily find the diagnoses and treatments I’d received over the years.
Note: One more clarification that needs to be made in the cited medical records pertains to a reference to an ER record by my GP (a note taken out of context of the actual ER record). I had to go to the ER due to the sudden worsening of GI symptoms ie worsening abdominal pain and distension due to adverse reaction to medications. Adverse reactions to medications are common in the chemically injured/sensitive. And, while I was dealing with a personal matter, it wasn’t what was stated by the GP (I would know!). And even though at the hearing I pointed out the inaccuracy it didn’t matter, the judge included it anyway. I was seeing the GP because the abdominal pain had not resolved. Diagnostic testing eventually found an intestinal infection was the primary cause of the the abdominal pain. In other words there was a physiologic cause found. The cause was not psychogenic as the GP and another doc misdiagnosed (just a rhetorical questions: do men get accused like women tend to that their symptoms are “psychogenic”?). Compare this to the Social Security Disability judge who got both the ER record and the diagnostic GI CDSA test who in his Decision cited my “adverse reactions to medications and sensitive gastrointestinal track”. He never once in his Decision mentioned or blamed psych causes for my GI symptoms or any other of my other conditions. Also, I did extensive psych testing for Social Security Disability as well as for my neuropsych eval and was found to be emotionally healthy with no psychopathology. WC used a few statements by physicians who misdiagnosed the cause of my abdominal pain to try and paint me as a psych case! Then the WC judge wouldn’t even allow my neuropsych eval into evidence which would counter that claim.
Methacholine Challenge Test
Also, much was made of my negative methacholine challenge test i.e. that it was proof that I did not have RADS that both the toxicologist and my environmental doctor had diagnosed. According to the article below it is not necessary to have a positive methacholine challenge test to have a RADS diagnosis so my two doctors were not wrong. Also, I had always reported that my pulmonary symptoms resolved a couple of months after leaving work. The methacholine challenge test was done three months after my pulmonary symptoms resolved.
Here are excerpts from an article on the methacholine challenge test in the chemically injured:
“This Test Can Harm Chemically Injured Lungs– A harmful test used for lung function analysis that can exacerbate chemically injured patients is methacholine challenge. Methacholine is a respiratory irritant. Its use in reactive airway disease can result in false diagnosis (of no lower airway problem) and/or prolonged exacerbation of reactive airway disease. It is thus medically contraindicated in patients with reactive airway disease (who by definition are worsened by breathing irritants) such as chemical injury patients.
Serious Side Effects Can Occur- Severe bronchoconstriction (closing of bronchial tubes) can occur with methacholine.
This Test is Not Medically Needed for Chemical Injury– Methacholine is a substance used to diagnoses conventional allergic (IgE) asthma. It was not developed to diagnose reactive airway disease, which has a completely different physiologic mechanism: neurogenic inflammation. Allergic asthma has symptoms of itching, sneezing or even eczema. Chemical injury has symptoms of burning, rawness and stinging irritation.
This Test s Not Reliable For Reactive Airway Disease (RADS)– the methacholine challenge has been found to be not a reliable predictor of airway hyperactivity (study of non-smoking persons with airway hyperactivity to irritants.) Its value is also unscientific, as it does not show correlation with patients who react to scented products, etc. Methacholine test results often change over time in the same patient and are not a good predictor of respiratory symptoms.”
Source: Contact me and I will send you the full article with references.
Re: the mentions of the accounting classes (which I had started several years earlier) yes I wanted to try and complete my associate degree so that I could work from home, especially after developing chemical sensitivity. However due to the orthopedic injuries I had to stop taking classes in the Fall of 1998 and was unable to take any classes throughout 1999 due to the chemical injury and did not resume them until latter half of 2000. Even my environmental doctor encouraged me to resume classes in 2000 so that I could try and work from home. When I resumed classes I ended up getting pesticide poisoning from the classroom (per the cholinesterase test ordered by my environmental medicine doctor). This was despite the fact I wore a mask and took an air purifier to class. The Social Security judge referred to this setback in his Decision writing “the claimant attempted to return to college classes, but had a setback when she was exposed to pesticides while attending school.” He also cited the voc rehab expert I had worked with for over a year after leaving work who”determined that such an individual could not return to past relevant work as dieitician” The Social Security judge also stated in his Decision “her work record speaks to her benefit in determining credibility”.
Residue/particles emitted from floor burnisher
The residue was a fine gritty dust. Apparently the more correct term is particles according to the Rules of Floor Burnishing article below. But I am going to continue to refer to it as residue. As for co-workers not noticing it in the office I believe it was because it was not making them sick. I was getting severe migraine headaches from the residue so I noticed it but had no idea what it was or where it was coming from. I took my vacuum from home in twice to the office after hours to clean it up to see if that would help my headaches. I later complained to Facilities Management about the residue. They installed white filters in the vents on ceiling to see if it was coming from the ventilation system but the filters remained clean. Later two men from Facilities Management came into the office to find me and told me they had figured out where it was coming from. They told me that it was coming from the floor burnishing machine and explained that if the machine was stopped too quickly it would rotate in place and create this residue and that it was blowing into the office (see Rules of Floor Burnishing below). Right after that the residue stopped so I assume that is when the air flow in the office was changed to a positive pressure which meant the residue from the hallway was no longer blowing into the office. It’s not true that it was always a positive pressure and that there was never any residue blowing into office as was stated at the hearing. In fact Facilities Management told me the source of it otherwise I would never have figured it out on my own. And they said it was blowing into the office. It wasn’t until I complained that the residue stopped which is when I believe the air flow was changed to positive pressure. Note: the office door was located at the end of a long hallway so residue was probably coming from more than just right in front of door but from all along this hallway as well. Also note the very last sentence in the following article stating “it is always a good idea to vacuum or dust mop after burnishing to prevent dust from being spread throughout the facility”.
“Rules of Floor Burnishing
- Always Clean The Floor First. With the thermal action that occurs with burnishing, any soils on the floor will be melted into the finish. The only way to remove burnished in soil is to scrub the finish, grinding off finish until the contaminated layers are gone.
- Always dust mop prior to burnishing floor finish. This removes any large particles that can become trapped in the pad and damage the finish or even the floor. Also objects such as rocks, pencils and even hard candy can become a dangerous projectile when flung from the high speeds of a floor burnisher.
- Keep moving. Unlike buffing floors with a low-speed machine, burnishers need t keep moving. Holding the burnisher in one spot will literally burn the floor. There is not reason to do anything but walk at a regular pace when using a burnisher to polish floors. Moving in a simple back and forth motion similar to cutting grass will give you even and effective results.
- Change your pad often. Floor burnishing with a clean pad is essential to floor polishing success. When too much dirt accumulates on the pad, it begins to be melted into the floor. It is always a good idea to inspect the pad often. This is to assure there hasn’t been any debris picked up and held in the pad.
- Dust Mop After Burnishing. During the process, microscopic floor finish dust particles are sanded away. These will become airborne and can be inhaled. Even if your burnisher has a dust control system, it is always a good idea to vacuum or dust mop after burnishing to prevent dust from being spread throughout the facility.”
I will admit it was hurtful to have some of my former co-workers testify on behalf of the other side. But I have never held it against them. I know chemical sensitivity is a very difficult medical condition for others to understand and believe. Believe me I was confused by the condition for a long time myself! Also, I know that I put my co-workers in a bind when I had to walk off the job without notice the week after the construction project started leaving them short staffed. I am truly sorry this happened. I had continued to work though ill for five months after developing chemical sensitivity. I was trying to stick it out as I was single and had no other means of income. But I became too ill to continue once that construction project started with the drastic worsening of the air quality. During the five months I worked ill with chemical sensitivity I seldom revealed it to my co-workers and supervisors because it was such a confusing condition and when I did say something it seemed I was not believed. At the hearing a couple of co-workers said that after I left work they had seen me without a mask. Later I told this to the nurse at my environmental medicine physician’s office and she laughed and said wearing a mask or not doesn’t mean someone has chemical sensitivity or not. Actually, once I found the 3M carbon mask that was very helpful, I did wear a mask inside buildings for many years after the injury. As for the person with asthma and others in the office not having any reaction everyone is individual and has a different susceptibility. Many factors play into a person’s susceptibility i.e. genetic predisposition, health at the time of exposure, total body toxic load at time of exposure, amount of time exposed (I was the only one in the office who worked overtime hours). Just because the person with asthma or others in the office did not get sick does not mean I could not react and get sick. Note: Not a single expert on our side ever asked me whether anyone else in the office became sick. They looked at the MSDS sheets that the hospital provided for the chemicals I was exposed to in my office and determined they caused my injuries and illness.
MCS is an invisible disability as the following You Tube video explains so well.
I do wish more of the evidence for my WC case, that I have outline above, would have been presented on my behalf. Even so it was our side that had the overwhelming evidence to support my claim. We had the written assessments from highly trained scientists and medical doctors in the areas of toxicology, environmental medicine and chemical injury which included my treating environmental medicine physician. All these experts concluded I had been injured by workplace chemicals. Unfortunately the WC judge did not put weight on my treating physicians and other experts and instead went with the other side’s witnesses who were not experts in the field of toxic injury. The Social Security Disability judge on the other hand put weight on my treating physician, a highly respected environmental medicine physician.
I hope things have improved for the newly chemically injured today when trying to find medical help and when making a WC claim. But based on my experience I would suggest they not file a claim unless they have the following:
–If you are claiming neurocognitive impairment it is recommended that you have a neuropsychological evaluation performed. “A person who has suffered a serious chemical injury is likely to have suffered considerable damage to his or her brain and nervous system.” Source: Recognizing Neurotoxcitiy by Raymond Singer and Dana Darby Johnson http://neurotox.com/project/recognizing-neurotoxicity/
–Find a lawyer experienced in chemical injury cases. It will make all the difference in your case!
–Make sure your supportive objective data ie records, lab work, tests and treatments get included in your case. In my case two of my most important supportive documents ie the diagnostic GI test showing damage to my GI tract from the solvent injury and treatment with antibiotics as well as the neuropsych eval showing neurocognitive damage from the solvent injury did not get included in my case! Also, I saw no evidence that that my work performance or voc rehab records got entered into my case. And I also saw no evidence that the pictures of the rash on my neck that I had submitted got entered into my case.
–Have several witnesses who support your case. Such as a voc rehab expert, etc.
–Hope you get a judge who recognizes chemical injury, systemic reactive disease including RADS and RIDS, neurocognitive damage and chemical sensitivity.
–Be prepared to defend attacks on your background, medical records, character, etc. Also be prepared for WC to use underhanded tactics. For example in my case they took medical records out of context, enlisted physicians for their opinions who were not experts in toxic injury, provided them with incomplete records then submitted their inaccurate opinions on the last day so no chance to provide rebuttal evidence. Also, they did not allow into evidence my neuropsych eval which would have shown the neurocognitive damage from the solvent injury and disproven the psych charges made by a couple of doctors not experienced with chemical injuries. I underwent two days of testing for this neuropsych eval it was so thorough and it was very pertinent to my case yet WC didn’t want to see it. I had a good work performance record for 22 years which the social security judge said lent credibility to my claim. He also stated my disability was due to a work related chemical injury. Recently a visitor to my home was questioning me about my sauna. I said I had to do about 2 hours of sauna every couple of days due to having chemical sensitivity. They asked me how I developed this condition and I explained it was from a workplace solvent injury and they said ” I hope your employer is still paying you”. No my employee did not take any responsibility for the injury and the government, ie taxpayers, had to foot the bill! It is my understanding this is par for the course for a work related chemical injury.