Environment and Health: What We Don’t Have Time to Tell You in the ED

(Part 1 of 3 Part Series)

The environment we are exposed to increases our risk of illness even when we cannot see it. Our current system for meeting energy needs results in most of us becoming locked into wasteful consumption. Generation of electricity, food production, transportation and manufacturing, lead to visible and invisible byproducts and waste that pollute our air, water, soil, as well as, the structures we occupy.

In my home state of Maryland, where respiratory diseases are leading causes of death and illness, smog has been identified by the CDC and Department of Health as a major culprit. Chronic obstructive pulmonary disease is now the 4th leading cause of death in the state. That ranks us 5th in prevalence across the nation. Asthma affects approximately 12% of the children in Maryland. The rates are more likely to affect us if we live in urban and low income areas that are more frequently located near areas of noxious land use. Vehicle exhaust and other combustion processes used in industry result in the production of chemicals such as benzene, a known cause of acute respiratory distress syndrome. Coal ash dust from trash incinerators correlates with greater incidences of asthma. Chlorine gas exposure can lead to lung disease that mimics pneumonia. These are just a few of the numerous toxins that can affect our respiratory system.

Even diseases and public health risks we may come to believe are a thing of the past are very much still with us. Lead poisoning is a persistent threat in cities like Baltimore, where lead-based paint was used in homes built through 1978. Lead is still frequently present in paints that were used for door and window frames, stairs and railings. It can even be in toys, batteries, crystal and pottery, if like many of us, you buy goods manufactured outside the U.S.  Especially if you are an expecting mom or have a young child living with you in an older home, you should be screened for lead poisoning. There is treatment available called chelation therapy, with agents such as succimer and penicillamine, that can reduce high levels of lead in your blood and protect from serious effects such as brain damage, but only if the problem is detected early.

Industrial sources of environmental pollution include those from metal processing in refineries, coal burning in power plants, petroleum combustion, and nuclear power stations. Heavy metals such as arsenic, cadmium, chromium and mercury are highly toxic and are more likely to cause harm the closer you live to a landfill or the more benign sounding “transfer station”, a building or processing site for the temporary deposition of waste before it is moved to a landfill. Coal ash is also correlated with high rates of lung cancer. I won’t try to catalog an exhaustive list of potential threats here, it would just be too long. Just know that invisible toxins, like Radon gas, can seep up from the foundations of houses to cause cancer, and are imperceptible to us as we go about our lives. We would be naive to assume that government can or does make us aware of all of these threats and can monitor every harmful chemical in our living environments. Many of these toxic byproducts come from multiple sources, so even if amounts detected from one source are below a predetermined safe limit, given multiple sources encountered by any one individual person, we could still be exposed to above-safe levels overall.

If you work in agriculture or gardening for instance, you are at increased risk for exposure to insecticides called organophosphates, which block an enzyme you need for normal nerve conduction. Exposure may manifest as muscle twitching, vomiting and diarrhea, leading to frequent trips to the emergency department for what may be an undetected cause.  Understand that mild symptoms can lead to serious disease and even death, so wearing a mask to protect yourself from these chemicals is a must. If you find yourself feeling sick over and over again, make sure you disclose it to your doctor and raise the question of a potential toxic exposure from your work.

If your job involves blasting into the earth, asphalt or concrete, or if you live near an area of heavy construction, you are exposed to harmful dust, which may contain silica that can cause a condition called silicosis in your lungs. This increases the likelihood of developing chronic bronchitis and chronic obstructive pulmonary disease. Beware that a chronic cough which seems to have no other explanation, even if you don’t smoke, can cause emphysema. You may even see workers wearing masks, so steer clear if you live near such ongoing  construction sites or projects.

Construction work can additionally put you at risk for exposure to inhaled fumes from solvents and paints called hydrocarbons, such as nitrous oxide and formaldehyde. These can cause respiratory problems and skin eruptions and symptoms often start out as a mild sore throat or watery eyes. They can even land you in a hospital emergency room with acute onset of chest pain and lead to longer term devastation like cancer.

If in addition to these exposures, you chose to smoke, you can almost guarantee you will be creating business for hospitals and healthcare systems as well as potentially irreversible illness in addition to needless cost for yourself and your loved ones. Physicians know this and often advise patients to stop smoking, but those warnings may not carry as much weight as they once did. What if we told you that cigarette smoke still also contains benzene, the known carcinogen mentioned above? Often, patients don’t appreciate the gravity of the situation and consider this advice that health care workers are compelled to give by protocol. After all, ‘doctors used to smoke’ as some of my patients are quick to point out. Ask yourself if you see many of those doctors around anymore.

Some of our foods are sources of risk for toxic environmental exposures. As a result, current FDA guidelines recommend fish consumption only 2-3 times per week, even then with the advice that the fat should be trimmed or drained. This is in part because fish and shellfish can concentrate toxins, such as mercury, from the water into their fatty tissue which can in turn cause nerve and kidney damage in humans who consume them. Similarly, polychlorinated biphenyls (PCBs), can accumulate in seafood and lead to skin, liver and gastrointestinal cancer. Many of these toxins are found in multiple additional sources throughout our environment. Although policy changes have prohibited the use of PCBs in plastic production in the U.S., their chemical stability allows plastics with PCBs to remain in the environment for decades, cycling through our air, water and soil.

Current energy, food and goods production policies will not, by themselves, protect us from a spectrum of toxic and potential lethal exposures that lead to disease and the deterioration of health. We each must become more responsible for understanding the risks of continuing on our present path. As consumers we must face the fact that we, along with industry, share in the unrealized costs to our health and to our society.

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