Transcript perecelsus, poe and ozone - MCS REFERRAL & RESOURCES

Multiple Chemical Sensitivity
... or MUSES Syndrome ?
Presented to the
Occupational Medicine Residents’ Seminar Series
Environmental & Occupational Health Sciences Institute
Rutgers University, Piscataway NJ
17 February 2004
by Albert Donnay, MHS, [email protected]
MCS Referral & Resources, www.mcsrr.org
(c) 2004 by ALBERT DONNAY
What is Multiple Chemical Sensitivity ?


1999 Consensus Definition (Arch Env Health 1999;54:147-9)
[1] MCS is a chronic condition
[2] marked by multiple symptoms in multiple organs
[3] that recur reproducibly
[4] in response to low levels of exposure *
[5] to multiple unrelated chemicals and
[6] improve or resolve when incitants are removed.
Best of 7 MCS Definitions at identifying MCS cases
(McKeown-Eyssen et al, Arch Env Health 2001;56:406-12)
(c) 2004 by ALBERT DONNAY
How Many MCS Symptoms Have Been Reported ?
List compiled by JHU Multi-Center Study of MCS Immunology
 CARDIOVASCULAR
9
 DIGESTIVE
18
 EARS // HEARING
7
 EYES // VISION
12
 GENITO-URINARY 10
 HEAD
6
 MOUTH // TASTE
14
 MUSCULOSKEL.
14
 NECK
3
 NERVOUS
SYSTEM 43
 NOSE // SMELL
10
 SYSTEMIC // OTHER 17
 VASCULAR
5
 REPRODUCTIVE
17
 RESPIRATORY
6
 SKIN // TOUCH
7
 THROAT
5
TOTAL # SYMPTOMS = 203
(c) 2004 by ALBERT DONNAY
What Objective Findings Are Reported in MCS ?
 Abnormal
Blood & Plasma
 Impaired Circulation
 Impaired Heart Function
 Impaired Detox Pathways
 Ear & Hearing Abnormalities
 Endocrine Deficiencies
 Eye & Vision Abnormalities
 Gastrointestinal Impairment
 Immune System Activation
 Increased Mast Cells
 Mineral Deficiencies
Musculoskeletal Abnormalities
 Neurocognitive Deficiencies
 Nose & Smell Abnormalitites
 Porphyrin Enzyme Abnorm.
 Respiratory Impairment
 Sensory Nerve Impairment
 Skin Tone Abnormalities
 Vestibular Impairment
 Vitamin Deficiencies
 Xenobiotics in Fat, Blood,
Urine and Hair
Refs online at www.mcsrr.org

(c) 2004 by ALBERT DONNAY
Who is Funding This MCS Research ?
 Most MCS-related
papers do not acknowledge any funding !
 But 10 US federal agencies fund over $25M per year: ATSDR,
CDC, DOD, DOE, DVA, EPA, NIDCD, NIEHS, NIH & NIOSH
 US Dept of Defense also funds MCS studies of UK veterans
 State governments in California, Maryland, Missouri, New
Jersey, New Mexico & Washington have funded MCS studies
 Both patient support groups (eg. CIIN) and chemical industry
front groups (eg. ESRI) have funded MCS conferences and
pilot studies that reflect their respective biases.
(c) 2004 by ALBERT DONNAY
Which View Predominates: Physical or Psychiatric ?
Overlaps:
Only 11% of
First Authors
and 30% of
Publishers
have ever
supported
more than
one view !!!
(c) 2004 by ALBERT DONNAY
On What Do All Agree? Prevalence is Very High !
5
US studies find 28% - 37% of adults say they are
“especially sensitive” to common chemical exposures
 4 US studies find 15% - 17% say they’re “unusually sensitive”
 6.3% in CA and 1.9% in NM say they have been diagnosed
by a medical professional with MCS or “environmental illness”
 US, Canadian and UK studies of Gulf War veterans all find
an increased prevalence of (still undiagnosed) MCS with a
relative risk of 2 to 4 compared with undeployed era controls
 Whatever cause(s), must be very common and moreso in war.
(c) 2004 by ALBERT DONNAY
But is MCS Only a Disorder of Chemical Sensitivity ?


NOT JUST ODORS: LIGHT & SOUND HYPERSENSITIVITY
are very strongly associated with MCS: p < 0.00001
(Miller, Tox Ind Health, 1999;15:370-85)
When asked, many MCS patients also report chronic
hypersensitivity to:
In poll of MCS patients in London
audience at this point, approx. 75
reported having all these sensory
sensitivities since ill. Only one
(an American) reported having just
chemical sensitivity, aka pure MCS.
SPICY FOODS // FLAVORS
TOUCH // PRESSURE // PAIN
HOT or COLD WEATHER
ELECTROMAGNETIC FIELDS
HEAVY METALS (NICKEL JEWELRY)
MENTAL or PHYSICAL EFFORT // STRESS OF ANY KIND
(c) 2004 by ALBERT DONNAY
Might MCS Be Something Else as Critics Claim ?
 MCS
not new or unique in English or French medical literature.
 At least 136 similar syndromes “Discovered” before & since.
 Few acknowledge any relation to any others, past or current.
 Few propose any specific cause, etiology, biomarker or cure.
 Most names never widely adopted or eventually abandoned.
 But some are still in use and many MCS cases are still being
diagnosed by one or more of them depending on the doctor.
 History reveals both consistency of underlying syndrome and
great inconsistency of evolving medical awareness, proving
doctors rarely ever discover any NEW disorders, just ones
they forgot, were never taught or did not bother to look up !
(c) 2004 by ALBERT DONNAY
First Described in 1733 by Dr. George Cheyne
as the English Malady (EM), aka ‘The Vapours’
 “To enumerate all
the almost infinite Symptoms, Degrees and Kinds
of Vapours is impossible, and perhaps very little to the Purpose.”
 “In general … the symptoms are many, various, changeable, shifting
from one Place to another, and imitating the Symptoms of almost
every other Distemper described.”
 “Those who suffer … are all of weak Nerves, have a great degree of
sensibility; are quick Thinkers, feel Pleasure or Pain the most readily,
and are of most lively imagination.”
 “Not withstanding all this, the Disease is as much a bodily Distemper
as the Small-Pox or a Fever.”
 Worst in winter & cities. Blamed on bad air, bad diet & bad habits.
(c) 2004 by ALBERT DONNAY
Some Symptoms of E.M. Cited by Dr. Cheyne
“Sometimes there is an Inflation, and an actual visible
Swelling, to a very considerable Bigness, in the Stomach to be
seen, especially in the Sex [women];
… a Coldness or Chilliness upon the Extremities, and
sometimes Flushing and Burning in the Hands and Feet,
Cold Damp Sweats, Faintings, and Sickness …
… Head-aches either behind or over the Eyes …
Flies and Atoms dancing before the Eyes, a Noise like the dying
Sounds of Bells, or a Fall of Water, in the Ears; Yawning, and
Stretching, and sometimes a Drowsiness or Lethargy, at other
times Watching and Restlessness,
and several other Symptoms, which it is impossible to
enumerate. Some have but a few of these Symptoms, and some
all of them, and a great many more.” [emphasis in the
original]
(c) 2004 by ALBERT DONNAY
36 Focus on Allergy, Sensitivity, Neurology or Toxins
1733 The English Malady
aka The Vapours
1769 Dysesthesia
1837 Neuropathy of
Nervousness
1849 Nervosisme (France)
1861 Ménière's Disease
1869 Neurasthenia >1K*
1892 Hyperaesthesia
1894 Autointoxication
1921 Chronic CO Poisoning
1930 Heat, Cold and & Effort
Sensitiveness
1930 Allergic Toxemia
1945 Allergic Fatigue
and Weakness
1945 Hyperventilation Asthma
1952 Allergy of Nervous System
1954 Cerebral Allergy
1956 Specific Adaptation Syn.
1957 Familial Dysautonomia >9K
1965 Minimal Brain Dysfunction
1965 Delayed Hypersensitivity
Reaction >4K
1973 Sensory Integrative
Dysfunction
* 1K = 1000 references
on PubMed
(c) 2004 by ALBERT DONNAY
Allergy, Sensitivity, Neurology or Toxins continued …
1990 Chronic Habitual
1978 Chemical
Hyperventilation Syn.
Hypersusceptibility
1994 Gulf War Syndrome
1979 Perinatal Hypoxic1996
Multi-Organ
Dysesthesia
Ischemic Cerebral Syn.
1998 Toxicant Induced
1982 Total Allergy Syndrome
Loss of Tolerance
1983 Sick Building Syndrome 1999 Eco-Syndrome
1985 20th Century Syndrome
1999 Multi-Sensory Sensitivity,
1985 Allergic Irritability Syn.
aka MUSES Syndrome
1985 Environmental Hypersensitivities
1986 Hypersensitivity Syndrome
1987 Darkroom Disease
1987 Multiple Chemical Sensitivity <1K
(c) 2004 by ALBERT DONNAY
30 Focus on Variations of 1869 Neurasthenia:
1875
1881
1886
1887
1889
1890
1891
1893
1895
1897
1898
Spinal Neurasthenia
American Nervousness
Sexual Neurasthenia
Gastric Neurasthenia
Neurasthenia
Praecox (aka Male N.)
Psychosomatic
Neurasthenia
Female Neurasthenia
Syphilitic Neurasthenia
Senile Neurasthenia
Traumatic Neurasthenia
Encephalasthenia
1903
1906
1907
1907
1908
1909
1968
Disease of the Century
Tropical Neurasthenia
Endocrine Neurasthenia
Ocular Neurasthenia
Digestive Neurasthenia
Battleship Neurasthenia
Pseudoneurasthenic
Syndrome
1976 Organic Neurasthenia
1976 Neurasthenic
Musculoskeletal
Pain Syndrome
(c) 2004 by ALBERT DONNAY
Variations of Neurasthenia continued …
1980 Neurasthenic Neurosis
1988 Neurasthenic Fatigue
Types of Unknown Origin and Date Cited by Secondary Sources
and/or Listed in Stedman’s Medical Dictionary








Angiopathic Neurasthenia
Cardiac Neurasthenia
Cardiovascular Neurasthenia
Insania Neurasthenia
Neurasthenia Chemicorum
Neurasthenia Gravis
Post-viral Neurasthenia
Pulsating Neurasthenia
(c) 2004 by ALBERT DONNAY
42 Focus on Psychiatry or Behavior
1765 Nervous, Hypochondriac
or Hysteric
1766 Hypochondriasis,
aka Hyp or Hypo
1859 Briquet’s Syndrome
1871 Hebephrenia
1895 Anxiety Neurosis >28K
1904 Phrenasthenia
1906 Psychasthenia
1912 Autism >6K
1914 Shell Shock Syndrome
1916 Battle Fatigue Syndrome
1918 War Neurosis
1930 Generalized Anxiety>1.5K
1938
1944
1947
1951
1957
1957
1965
1965
1966
1966
1966
1967
1968
Suburban Neurosis
Asperger’s Syndrome
Old Sergeant Syndrome
Munchausen’s Syn >1K
Psychogenic Dyspnea
and Hyperventilation
Traumatic Neurosis
Asthenic Neurosis
Psychogenic Pain Syn
Psychovegetative Syn
Accident Neurosis
Hyperactive Child Syn
Post Accident Anxiety Syn
Chronic Factitious Illness
(c) 2004 by ALBERT DONNAY
Psychiatry or Behavior continued …
1981 Somatization Dis. >7K
Pseudo Combat Fatigue
Hyperkinetic Behavior Syn 1988 Attention Deficit
Hyperactivity Disorder,
Ecologic Mental Illness
aka
ADHD,
>6K
(count
Psychalgia
includes ADD & HCS)
Epidemic or Mass Hysteria 1995 Environmental
Pinocchio Syndrome
Somatization Syndrome
Mass Psychogenic Illness 1996 Iatrogenic
Psychic Possession
Hypochondriasis
Post Traumatic Stress
1996 Idiopathic Environmental
Intolerances (not WHO)
Disorder >6.5K (count incl.
1999 Functional Somatic
Traumatic Neurosis)
Syndromes
1981 Attention Deficit Disorder
1981 Pervasive Developmental Disorder >7K
(c) 2004 by ALBERT DONNAY
1968
1968
1973
1973
1974
1977
1978
1978
1980
28 Focus on Infection, Trauma, Fatigue or Pain
1857 Remittent Fever,
aka Crimea Fever
1866 Railway Spine
1871 Irritable Heart,
aka DaCosta’s Syndrome
1887 Undulating Fever,
aka Malta Fever
aka Mediterranean Fever
1904 Fibrositis
1934 Chronic Brucellosis
1936 Morbid Industrial Fatigue
1938 Neurocirculatory
Asthenia,
aka Effort Syndrome
1941 Chronic Fatigue
1950 Epidemic Neuromyasthenia
aka Icelandic Disease,
aka Akureyri Fever
1956 Encephalomyelitis
simulating Poliomyelitis,
aka Royal Free Hospital
1956 Benign ME, aka Myalgic
Encephalomyelitis <100
1957 Epidemic Postinfectious
Neuromyasthenia
1958 Irritable Colon Syn
1959 Irritable Bowel Syn >3.5K
(c) 2004 by ALBERT DONNAY
Infection, Trauma, Fatigue or Pain continued…
1960
1970
1975
1982
1984
1986
1987
1988
1990
1997
1998
2001
Temporomandibular Joint Pain >3K
Myofascial Pain Syndrome >4.5K
Fibromyalgia >2.5K**
(Familial) Chronic Mononucleosis
Chronic Active Epstein Barr Virus
Sporadic Postinfectious Neuromyesthenia
Chronic Fatigue Syndrome >2K**
Chronic Fatigue and Immune Dysfunction Syndrome
3 types of Asthenia: Episodic, Recurrent and Chronic
Chronic Pain and Fatigue Syndrome
Chronic Multi-Symptom Illness
Chronic Neuroendocrineimmune Dysfunction Syndrome
(c) 2004 by ALBERT DONNAY
In USA, Not Even “Discovered” By Physicians:
First Described in the Tales of Edgar Allan Poe
 1832: 1st
Report of Symptoms in Loss of Breath
 1839: Over 50 Specific Symptoms in Fall of House of Usher
 1839: 1st Report of Facial Sign in The Man Who Was Used Up
 1840: 1st Report of Cause in Philosophy of Furniture
 1843: 1st Report of Psych Misdiagnosis in The Tell Tale Heart
“Now have I not told you that what you mistake for madness
is but overacuteness of the senses?”
 1844: 1st Report of Successful Therapy in Premature Burial
 1849: Poe dies as he predicted of “Congestion of the Brain”
(c) 2004 by ALBERT DONNAY
But Only Charles Baudelaire in Paris Recognized
Gas Lighting as the Cause of Poe’s Symptoms
 "All
the documents I have read led me to the conviction that
for Poe the United States was nothing more than a vast prison
which he traversed with the feverish agitation of a being
made to breathe a sweeter air
— nothing more than a great gas lighted nightmare —
and that his inner, spiritual life, as a poet or even as a drunkard,
was nothing but a perpetual effort to escape the influence of this
unfriendly atmosphere."
 Gas light made from coal contained 5 % to 50 % Carbon Monoxide
 CO exposure limits today= 0.0009 % outdoors, 0.005% occupational
(c) 2004 by ALBERT DONNAY
“Do you know why I so patiently translated Poe?
It was because he was like me.”
REVERSE IMAGE
EDGAR ALLAN POE
TRUE IMAGE
CHARLES BAUDELAIRE
(c) 2004 by ALBERT DONNAY
“And there
was
perceptible
about them
[his eyes],
ever and anon,
just that
amount of
interesting
obliquity…”
EA Poe, 1839
(c) 2004 by ALBERT DONNAY
Many Other 19th Century Creative Geniuses
Also Apparently Poisoned by CO from Gas Lighting
George Bernard Shaw
Oscar Wilde
(c) 2004 by ALBERT DONNAY
Evidence of Van Gogh’s
gas light poisoning, like
Poe’s Tell Tale Face
and his Purloined Letter,
is “hidden in plain view”
Gaughin’s Chair
painted by Van Gogh in
their gas-lit Yellow House
in Arles in Nov. 1888,
one month before
Van Gogh cut off his ear.
(c) 2004 by ALBERT DONNAY
Of Course, Not Just Men and Not Just Then
Jane Austen
J.K. Rowling
(c) 2004 by ALBERT DONNAY
Tell Tale Face Noted in “Certain Nervous Disorders”
Even Before Introduction of Gas Lighting
“Her left eyelid
remained permanently
half closed and
the right angle
of her mouth
was considerably
drawn aside.”
Edward Percival, 1813
(c) 2004 by ALBERT DONNAY
England’s Most Famous Unrecognized Case ?
King George III
1738 – 1820
Presumed now to have
inherited porphyria, but
CO poisoning was never
considered since his
illness began decades
before gas lighting.
(c) 2004 by ALBERT DONNAY
Most Likely CO Source
Prior to Gas Lighting
Coal bed warmer on display
in bedroom of KGIII’s grandmother,
Queen Caroline, Hampton Court
(c) 2004 by ALBERT DONNAY
CO Role in “MCS etc” Not Yet Widely Recognized:
Excluding Literature on Chronic CO Poisoning,
CO is mentioned in only 11 of 90,000 other articles
Fibromyalgia Syndrome
2: both claim “not CO”
Chronic Fatigue Syndrome
2: 1 claims “not CO”
the other says “from CO” so not true CFS !
Generalized Anxiety
1: claims “not CO”
MCS / MUSES Syndrome
1: claims “from CO”
Post Traumatic Stress Disorder
2: both claim “not CO”
Somatization Disorder
3: all 3 claim “not CO”
Even most MCS patients fail to recognize any CO connection,
perhaps because CO is odorless, tasteless and invisible.
(c) 2004 by ALBERT DONNAY
First Peer-Reviewed Publication Proposing
Connection Between MCS, CO and Poe
Donnay, A.
International Journal
of Toxicology
1999;18(6):383-392
“On the recognition
of multiple chemical
sensitivity in medical
literature and
government policy.”
(c) 2004 by ALBERT DONNAY
Subsequent Citations
(c) 2004 by ALBERT DONNAY
CO is Well Known as “The Great Imitator” and
Already Well Documented to Cause or Worsen:
 Anemia
 Depression
 Angina
 Diabetes
 Anosmia (loss of
 Asthma
 Birth Defects
 Blindness
 Deafness
smell)
 Hallucinations of
all kinds
 Heart
Disease
 Mental Retardation
 Parkinson’s
 Psychoses
(c) 2004 by ALBERT DONNAY
Why So Many Syndromes? CO is Both
Ubiquitous Neurotoxin & Ubiquitous Neurotransmitter
 CO
is #1 Cause of Unintentional Toxic Deaths in USA
 CO is #1 Cause of Unintentional Toxic Poisonings in USA
 CO is #1 Air Pollutant in USA: more tons/year than all others;
primarily from industry, vehicles, fires, combustion appliances
 CO is also produced systemically by all mammals from heme
breakdown by Heme Oxygenase, the Universal Stress Enzyme.
 HO-1 is greatly induced by exposure to any type of stress :
heat, bright light, noise, odors, drugs, alcohol and other
chemicals, trauma, infection, electro magnetic fields, etc.
 Endogenous CO is not just bound to hemoglobin but bioactive
in over 90 pathways in range of 1 to 10ppm
(c) 2004 by ALBERT DONNAY
Increased endogenous production of CO
from heme breakdown is documented in:
Allergy
Heart Attack
Altitude Sickness
Heat
Alzheimer’s
Anemia
Asthma
Bronchiectasis
Cystic Fibrosis
Diabetes
Stress / Stroke
Infections
Methylene Chloride Poisoning
Parkinson’s
Pre-Menstrual Syndrome
Upper Respiratory Tract Infections
(c) 2004 by ALBERT DONNAY
All CO-Related Disorders Share Biomarker:
Elevated Level of CO in End-Tidal Breath
 Normal
bCO (maximum after holding breath 20 to 25 seconds)
Healthy Relaxed Non-Smokers
= 0-2 ppm
 Mildly Elevated bCO
Borderline Abnormal for Non-Smokers
= 3-4 ppm
 Moderately Elevated bCO
Smokers and People with CO Disorders = 5-24 ppm
 Highly Elevated bCO
Recently Smoked or CO Poisoned
= 25-999+ppm
All healthy adults have approx. noon peak and midnight trough.
Higher after supplemental oxygen & if standing vs. sitting vs. supine.
(c) 2004 by ALBERT DONNAY
How CO Causes MUSES Syndrome
 HO-CO
controls sensitization and habituation to stressors of all kinds.
 Chronic repeated exposures to any stressor induces habituation,
so that higher doses are tolerated with less or no sensory awareness.
 Isolated acute exposures (and de-habituation, as in ex-smokers)
induce sensitization, so that lower doses are less tolerated with more
sensory awareness.
 While exogenous stressors (heat, drugs, alcohol) may be avoided,
endogenous CO produced by HO in response to ANY stressor cannot.
 So if/once sensitized to CO via exogenous poisoning or dehabituation,
increased sensory awareness may be provoked by ANY stressor.
 Result is multi-sensory sensitivity to odors, lights, sounds, foods, etc
aka MUSES Syndrome (aka MCS in adults or Autism in children).
(c) 2004 by ALBERT DONNAY
Where to Look for Evidence of CO Poisoning Today
• Test CO in end tidal breath after holding breath for 20 seconds
(healthy non-smokers are 0-2 ppm; chronic diseased are 5-10ppm).
• Test ABG & VBG at same elbow to see if PaO2-PvO2<55mmHg
• Monitor indoor CO levels with a digital detector near combustion
appliances, especially unvented ones like gas ovens and gas logs.
• Monitor CO levels inside homes with attached garages after
vehicles are started with the door open, driven out & the door closed.
• Monitor CO levels in motor vehicles while driving and parked idling.
• Look for asymmetrically drooping eye and mouth that mark
The Tell Tale Face of CO Poisoning and ask about multi-sensory
sensitivity to lights, odors, noises, tastes, touch and heat or cold.
(c) 2004 by ALBERT DONNAY
Curing MUSES Syndrome: Treatments
Proposed by Cheyne, Poe and Donnay
 Dr.
George Cheyne in The English Malady, 1733:
“Seldom any lasting or solid cure is perform’d … till they have sucked in
and incorporated the sweet balmy clear Air of the Country. … Diet will do
infinitely more than Exercise and have more lasting Effects, but both should
be joined. … Certainly the best of all is where Amusement or Entertainment
of the Mind is joined with Bodily Labour and Constant Change of Air.”
 Edgar Allan
Poe in The Premature Burial, 1844:
“I took vigorous exercise. I breathed the free air of Heaven.
I thought upon other subjects than Death. I discarded my medical books.”
 Donnay in
CO Dx-Tx Protocol, 2000: O2 @ 6 L/m, 2 hr/day for 3 mo.
(c) 2004 by ALBERT DONNAY
Conclusion: Distinguish MUSES from MCS !
MCS associated only with sensitivity to chemicals is rare.
 Most MCS cases also report multi-sensory sensitivity, aka
MUSES Syndrome, consistent with descriptions of over 130
other similar syndromes published since 1733.
 Sentinel case in USA of Edgar Allan Poe was most likely
caused by chronic CO poisoning from exposure to gas lighting.
 MUSES syndrome caused by chronic CO poisoning is
associated with a Tell Tale Face and PaO2-PvO2<55mmHg.
 Oxygen uptake deficiency and MUSES symptoms may be
treated successfully with daily supplemental oxygen at home.

(c) 2004 by ALBERT DONNAY
Published Critiques, Rebuttals & Objections
To Donnay’s Poe, CO and MUSES Theories
•
Unpublished Critiques, Rebuttals & Objections
To Donnay’s Poe, CO and MUSES Theories
•
(c) 2004 by ALBERT DONNAY