Three Sources Of Data
The same factors affecting the update of a chemical continue to operate inside an organism, hindering a chemical's return to the outer environment. Some chemicals are attracted to certain sites, and by binding to proteins or dissolving in fats, they are temporarily stored. If uptake slows or is not continued, or if the chemical is not very tightly bound in the cell, the body can eventually eliminate the chemical.
One factor important in uptake and storage is water solubility; the ability of a chemical to dissolve in water. Usually, compounds that are highly water soluble have a low potential to bioaccumulate and do not leave water readily to enter the cells of an organism. Once inside, they are easily removed unless the cells have a specific mechanism for retaining them.
Heavy metals like mercury and certain other water-soluble chemicals are such an exception, because they bind tightly to specific sites within the body. When binding occurs, even highly water-soluble chemicals can accumulate. this is illustrated by cobalt, which binds very tightly and specifically to sites in the liver and accumulate there despite its water solubility. Similar accumulation processes occur for mercury, copper, cadmium, and lead.
Many fat-moving (lipophilic) chemicals pass into organism's cell through the fatty layer of cell membranes more easily than water-soluble chemicals. Once inside the organism, these chemicals may move through numerous membranes until they are stored in fatty tissues and begin to accumulate.
The storage of toxic chemicals in fat serves to detoxify the chemical, or at least removes it from harms way. However, when fat reserves are called upon to provide energy for an organism the materials stored in the fat may be remobilized within the organism and may again be potentially toxic. If appreciable amounts of a toxin are stored in fat and fat reserves are quickly used, significant toxic effects may be seen from the remobilization of the chemical.
Chemical Accidents and Emergency Care:
Health Consequences for the Paramedic
By Anna Law, M.D. and Gerald T. Lionelli
Emergency care workers confronted with a chemically related incident must often act quickly, with little or no information as to the toxicity of the substances involved. Although precautions are generally followed to avoid acute, life-threatening exposures to concentrated fumes or vapors, evidence is gathering that repeated chemical exposures at quite low levels may also have adverse health effects, Consequently, it is important that EMTs (as well as EMS providers) recognize the symptoms of low-level contamination and the methods by which it may be treated or prevented.
According to a Department of Labor spokesman, more than 550,000 chemicals are in current use. Many are specifically designed to resist decomposition by heat, abrasion, or chemical reaction, and cannot be easily metabolized to the point of excretion by the body. A number are fat-soluble and tend to lodge in the adipose (fatty) tissues of the body, a process known as bio-accumulation. Exercise, stress, fatigue, illness, or normal metabolic processes routinely cause these compounds to be released from adipose tissues into the blood, resulting in contamination of body organs and organ systems. (Drug residues also store in fat, and their release may trigger the phenomenon of "flashback", or reactivation of the drug.)
PRECAUTIONS
Safety experts have suggested a number of guidelines which emergency rescue personnel may follow to reduce the likelihood of occupational exposures, among them:
1. As a general rule, some type of protective gear should always be worn. When there is any doubt about a substance, the most complete protection available should be employed, Remember that at fire sites toxic gases can be present long after the smoke has cleared. Gases created by burning synthetic furnishings include hydrogen chloride, hydrogen cyanide, carbon monoxide, and aceolin, all of which are harmful, and some of which are fatal Sight and smell are not adequate methods of detecting their presence, and must never be relied upon.
2. Protecting the respiratory tract is a primary consideration. Inhalation provides toxic materials with a direct path to the bloodstream and body organs and systems. Serious contamination may occur immediately. Respirators should not be removed until the risk of airborne contamination is eliminated. This means that respirators should not be removed until the worker is safely away from the contaminated zone (in the "safe zone") and his protective outerwear has been removed and containerized. As always, check the wind direction before removing respirators.
3. Remove contaminated clothing. It is not advisable to bring such clothing home for cleaning. (This has been discovered to be a primary route by which occupationally encountered toxic materials enter the home.) Leather cannot be fully decontaminated—boots, once saturated, will continue to expose the wearer even after they have been washed and dried.
4. Eating, smoking, and drinking at emergency sites provide additional routes through which toxins may enter the body
5. If dermal exposure does occur (especially to tissues around the eyes, mouth, or genitalia), it is important to rapidly wash and decontaminate before skin penetration takes place. Soap and water are usually effective for this purpose.
6. If contaminated garments are not removed from a person being sent to a hospital, the likelihood of skin and respiratory absorption is increased not only for the patient, but also for those treating him. Decontamination should take place as soon as possible following exposure.
7. If the patient must be transported while wearing contaminated clothing, the driver and other medical staff should be protected against toxic vapors and dermal exposure.
SYMPTOMS OF TOXIC BIO-ACCUMULATION
Despite routine precautions, it is possible that, over time, low level exposures will occur, with a resultant accumulation of toxic compounds in adipose tissue. Among the most common symptoms of toxic bioaccumulation are fatigue, headaches, muscle and joint pain, nervousness, memory loss, impaired coordination, gastrointestinal discomfort, insomnia, and diminished cognitive function. Chemically exposed persons often exhibit these symptoms in "clusters".
A study reported at the 1988 meeting of the American Public Health Association addressed the neurological damage experienced by firefighters exposed to hazardous chemicals (PCBs and their thermal byproducts) at a transformer fire. A team of researchers led by Dr. Kaye Kilburn of USC's Environmental Sciences Laboratory discovered that both the exposed firefighters and a control group of firefighters not present at the fire manifested neurological deficits. This strongly suggests the possibility of a gradual build-up in the body of harmful compounds. "It is interesting to speculate that the continuing neuropathy observed may, in some cases, be due to the persistence of these compounds in the adipose tissue", the researchers noted.
Kilburn and his associate Dr. Megan Shields, a Los Angeles physician, found that a detoxification method developed in the 1970's by L. Ron Hubbard enabled them to alleviate some of the adverse health effects they had observed. In the last decade, the Hubbard method has become the only method of human detoxification in broad clinical use. Reports published by the Royal Swedish Academy of Sciences, the World Health Organization's International Agency for Research on Cancer, and others, have shown it to be a safe and effective method of reducing body levels of common environmental contaminants and alleviating the symptoms associated with exposure to them.
The program is administered under medical supervision and employs a regimen of exercise, vitamins (including niacin), and low-heat sauna to mobilize stored toxins and facilitate their excretion through normal body channels. Physicians in the U.S. have treated nearly two thousand persons manifesting signs and symptoms of chemical exposure with this methodology.
Dr. David E. Root, a specialist in occupational medicine in Sacramento, specializes in treating chemical exposures. "Many approaches have been used to address this problem," he observes. "These methods do not, however significantly reduce body burdens, he adds, "which requires an enhanced mobilization of toxic fats into circulation, followed immediately by forced excretion. It is this sequence and the manner in which it is accomplished which makes the Hubbard method so effective."
Research relating to the health consequences of chemical exposure is ongoing. There is strong evidence that the combination of adequate protection from routine exposures and treatment measures such as detoxification will greatly reduce the likelihood that emergency healthcare workers will face chemical barriers to good health and professional success.
Anna C. Law, M.D., FA.C.E.P., is currently the Medical Director of the Emergency Department and the Paramedic Liaison Physician at Queen of Angels Hospital in Los Angeles.
Gerald T. Lionelli, M.S., is a project manager for the Naval Energy and Environmental Support Activity (NEESA), where he is developing a Navy-wide Risk Assessment program.
Detoxification and the Healing Response
by Barry Kapke, A.C.S.T., C.I.
‘Detoxification’ doesn’t have a very pleasant sound to it. It seems to imply an urgent response to a poisonous situation. Sometimes it is. However, detoxification is not something that only happens when we are in dire physical distress but is a normal ongoing activity of the body. It is a healthy response.
We are continuously taking aspects of our physical, sensory and emotional environment into our being, where we digest and assimilate some of that input and other aspects that are not useful to us are passed on for elimination. We breathe in oxygen and vital energy or qi from the air, and we release carbon dioxide and other volatile substances through our exhalation. We ingest food, some of which nourishes and becomes a part of our body, and the unusable aspects are expelled through our urinary and excretory systems
1. Our skin is an organ of intake as well as elimination, and through our physical contacts we absorb substances that enter systemic circulation, often adding to our toxic backlog. 2 In each moment, our sensory apparatus is bombarded by stimulation – sounds, sights, smells, tastes, sensations – and we filter that, digesting some and releasing the rest. These words and ideas that are entering your consciousness through this page – some will be deemed useful and you’ll retain; others you’ll allow to pass right on through. In Chinese Medicine, this is called ‘separating the pure from the impure.’In the very act of receiving input, we simultaneously are creating wastes or excreta. We take what we can use and let the rest go by. The discriminating and eliminating activity is a vitally important function. If we are not constantly releasing harmful or unhelpful substances and energies, we become cluttered, clogged up, and toxic.
We also are creating, from the inside, unwanted waste materials that must be eliminated. Biochemical and cellular activities generate substances that need to be disposed of. Muscle fibers convert glycogen to adenosine triphosphate (ATP), the energy source that muscle fibers use to make muscles contract. Lactic acid is a byproduct, responsible for the feelings of burning and soreness in exercising muscles. Living organisms within us, such as intestinal bacteria, yeasts, and parasites
3, produce metabolic wastes just as our own bodies do and it is up to us to clear these wastes out of our system.The body is designed to self-cleanse, to remove waste and toxic materials, and to clear space for new input. Internal detoxification is one of our most basic autonomic functions. Now, in addition to the normal range of unnecessary or harmful materials the body must purge on a daily basis, modern society adds an onslaught of unnatural substances to be dealt with.
Now, more than at any other time in history, we are subjected to a plethora of unwholesome and unnatural substances. Thirty-five percent of the food tested in the United States has residual amounts of pesticides and current tests detect only about one-third of approximately 600 pesticides in use in this country.
4 We have little way of knowing the toxic presence in foods imported from countries with more lax regulation.There are roughly 100,000 synthetic chemicals being produced and sold worldwide and another thousand are introduced each year. These substances which are not naturally-occuring and for which little safety data exists are everywhere – in our air, food, water, and things we touch. We breath them, eat them, and absorb them through our skin. This toxic overload severely taxes the body’s capacity to effectively deal with the dross needing to be removed.
As the body becomes overwhelmed, impurities accumulate. They are tucked away in whatever available spaces can be found, pending removal. Foreign substances that can’t be eliminated may be ‘quarantined,’
stored in mucus or fat so as not to trigger an immune reaction. Toxins can lodge around joints, forming crystals, or bind to proteins in interstitial tissues. Fat-soluble toxins will find their way into adipose tissues. Cholesterol will collect in arterial walls or as gallstones. Minerals may form stones in the kidneys and bladder. Glycoproteins form mucoid deposits in connective tissue.According to Ayurvedic Medicine, ingesting food of poor quality,
5 as well as incompletely assimilating food, creates ama, a sticky residue that can accumulate and block the circulatory channels or srotas.6 The prolonged presence of ama causes stagnation and generates toxins which may be transported in the bloodstream to various organs, cavities and joints of the body. The arising of all internal diseases may be attributed to the presence of ama in the body, and all diseases caused by external factors eventually produce ama.7Clearing Out the Garbage
Metabolic wastes that are not eliminated become sources of toxicity. Ama, and stagnation, creates toxicity. Anything in excess can become a poison. Detoxification is the body’s way of keeping things moving, thereby optimizing the quality of what the body has available to it for use and clearing out all that is of no benefit. However, when the body’s normal housecleaning processes are not adequate, especially where there is unusual exposure to environmental toxins or a chronic accumulation, it is beneficial to assist the normal detoxification process. Seasonal ‘housecleaning,’ particularly in spring and autumn, is helpful to the body but it is also important to not let the garbage pile up. Ongoing cleansing and attention to lifestyle is essential.
Food is our most basic medicine. One of the foremost concerns in attempting to eradicate toxicity and stagnation is to examine what is being introduced into the body. Is the diet appropriate for the individual? 8
Is there a high percentage of processed foods, with preservatives and additives, or is the diet one of fresh, simple foods? Is there adequate roughage? Is the body getting enough hydration?
9 Are meals consumed in pleasing, relaxed settings, with gratitude, or is it gulped down on the run or while reading a paper or watching television? Making basic changes in dietary intake and habits will usually have far-reaching consequences for the entire body.A sedentary lifestyle is quite debilitating to the eliminative processes. To support the body in removing wastes and toxins, it is important to move the body and to breathe. Unlike the blood circulatory system, the lymphatic system has no pump to keep things continuously moving. Through movement and muscle contraction, lymph, which contains metabolic wastes and other particulate wastes, is mobilized through the body, helping to filter out these toxins and to initiate an immune response to various pathogens. Deep breathing also helps with the transportation of lymph, as well as with the elimination of volatile wastes -toxins that vaporize and leave the bloodstream as gases. Yoga is a quite beneficial addition to almost anyone’s lifestyle, and is effective in, among many things, supporting the body’s detoxification processes.
Where the body needs more outside assistance to help discharge toxic materials, there are numerous cleansing programs that may be helpful. Information about various detoxification regimes is readily available from holistic health practitioners and books. One such approach, which I’ll just briefly describe, is the
panchakarma10 of Ayurvedic Medicine. ‘Panchakarma’ means ‘five actions.’ It is a three-stage process. In the first stage, preliminary practices of oleation11 (snehana) and therapeutic heat (swedana) prepare the body. The second stage involves the five cleansing actions for eliminating ama and restoring balance to the body; the five karmas are emesis (therapeutic vomiting), nasal therapy, purgatives, colon therapy, and blood detoxification. The final phase of the cleansing process includes treatments to strengthen and support the digestive fire and constitutional balance of the individual. These rejuvenating practices are then essentially repatterning our dietary and lifestyle habits. Panchakarma is traditionally administered by an Ayurvedic physician, but elements of it have found their way into spa settings.Within our own scope of practice, massage can be a powerful support to the body’s detoxification processes.
Massage and Detoxification
Massage provides an excellent means of helping release congestion and stagnation and to restore flow to the body. Whether by the effleurage and petrissage techniques of Swedish Massage (and related approaches) or by the compression and stretching actions of Asian modalities like Shiatsu and Thai Massage, toxins stored in body tissues are remobilized into systemic circulation from which it is hoped they will successfully be eliminated. Abdominal massage helps release toxicity from the organs and tissues and promotes their elimination through the colon, kidneys, and skin. Abdominal massage also is very beneficial in stimulating the bowels to reduce constipation, a chronic condition for a majority of Americans. Through the deepened breathing that often accompanies massage, toxic gases (and emotions) can be expressed.
Remember that body toxins are in part eliminated through the integumentary system. An Ayurvedic practitioner suggested to me that the layer of oil
12 we cover our client’s body with (for those that practice oil massage) becomes saturated during the course of the massage with exuded toxins. Therefore, it is important to remove that layer of oil at the end of the massage so these toxins are not reabsorbed in a more concentrated form.In India, oil is removed through the application of a flour paste called an ubtan. An ubtan can be made from one cup of chickpea (garbanzo) flour, one-half cup of mustard oil, and one teaspoon of tumeric.13
From that paste, add enough distilled water to form the consistency of a light cake batter. Apply it to the entire body (including the hair) with upward strokes. When the ubtan begins to dry and crack, it can be removed by gently rubbing, thereby energizing and exfoliating the skin, as well as removing toxin-laden oils. The body should then be washed, preferably without soaps which can strip the skin of its protective mantle and dessicate the pores. If soap is used, immediately apply a body lotion or oil to protect the skin until it can re-form its sebum layer. CAUTION: ubtans can clog your bathroom plumbing.
The Mei Gen or Healing Response
In assisting the body to dispose of its toxic load, massage may elicit a time-delayed reaction from the body that is less than pleasant. The client may report that they left the session feeling great but by the time they arrived home it felt like they’d been hit by a truck or they’d gotten the flu. This is often referred to as a ‘healing crisis’ and is not an uncommon follow-on response to massage. I prefer to call it a ‘healing response.’ In Asian Bodywork, it is called a
mei gen (or menken) reaction and according to traditional Japanese medicine a cure isn’t possible without a mei gen (healing response).A mei gen response is not something to be overly concerned about but it can be alarming if you don’t know what it is. For this reason, when I talk with new clients about massage I always list several of the typical benefits of massage and I include the healing response as a potential benefit.
A healing response is a natural part of the body’s reorganization towards balance and should be welcomed. As metabolic wastes and toxic residues are released from the tissues where they were being stored, they re-enter the interstitial fluids and then into the lymphatic network. This sudden appearance of toxic materials in the system, precisely those materials the body was having trouble eliminating, may jolt the body’s detoxification processes into action. Within the next twenty-four hours, the client may experience the flu-like symptoms of autointoxication – muscle soreness, aching joints, headache, nausea, lethargy, depression, fevers, chills, coughs, mental irritability, etc.
14 It is advisable to rest, drink lots of fluids, and take a hot bath to promote the elimination of these toxins. Usually, all of the unpleasant symptoms will disappear within a few days and the client will feel markedly better than they have in quite some time.When we experience unpleasant symptoms, it is tempting to take aspirin or some other drug to mask these feelings. However, that is just putting more toxins into the body and does not support the ongoing process of healing. A healing response is an opportunity to learn something new, to let go of old patterns and find a new way of being in the body. Instead of shutting it out, meditate on it. Engage with it. Experience the body change.
How do you know that it is a healing response and not something else? How do you know that you’re getting better, not getting worse? Constantine Herring, one of the founders of the homeopathic movement, put forth some guidelines (now called Herring’s Law of Cure) that may be helpful. When healing is taking place:
(1) Symptoms move from the inside to the outside of the body. For example, mucus in the lungs is coughed up; toxic residue in the organs erupts as boils or rashes.
(2) Symptoms move from the upper part of the body to the lower part. For example, medications that affect the kidneys, such as steroids, may be expressed as a rash on the legs.
(3) Symptoms related to chronic conditions disappear in the reverse order of their appearance. The most recent symptoms will disappear first and the early symptoms from the onset of the condition will reappear and be the last to be resolved. Naturopath John Garvy
15 added to this two more guidelines that help to differentiate a healing response from an advancement of illness.(4) A feeling of well-being precedes a healing response.
(5) During the healing response, there is a feeling deep down that something beneficial is going on. It is natural and normal for the body to neutralize and rid itself of accumulated wastes and toxins. This takes place through the colon, liver, kidneys and bladder, lungs, lymph, and skin. To this list of detoxification systems I would add ‘the mind.’ Thoughts, attitudes, beliefs, emotions, judgments – these are just as capable of poisoning us as any toxic material. Through mobilizing accumulated and stuck mental and emotional ama, and releasing it through consciousness, we may address the root causes of much suffering and distress. Cleansing practices and healing responses are opportunities to realign ourselves with more wholesome and harmonious patterns. With awareness, the healing crisis becomes the healing journey.
Notes
1
The three waste products (malas, in Ayurvedic Medicine) are feces (solid wastes), urine (water-soluble wastes) and sweat (water-soluble wastes). The skin is sometimes referred to as the third kidney, in that it is capable of functioning as an ancillary elimination channel when needed to take over some of the load normally handled by the urinary system.2
This is discussed in more detail in my article "Border Exchange: The Skin, Detoxification and Baths" in Massage & Bodywork (August/September 2000). See also: Mark Lappé, The Body’s Edge (New York: Henry Holt, 1996).3 Parasites, such as pinworms, roundworms, and tapeworms, and yeasts and fungi, such as candida, infest a major percentage of the population. This is not merely a problem in underdeveloped countries; it is a major, and often ignored, factor of disease in industrialized societies.
4
Rudolph Ballentine, M.D. Radical Healing. (New York: Three Rivers Press, 1999), 272.5
In addition to refined foods and other foods of low energetic value, tamasic foods are said to promote heaviness in the body, causing mental dullness, confusion, and physical lethargy, and they tend to create ama in the body.Tamasic foods include red meat, alcohol, mushrooms, deep-fried and fermented foods, and aged foods such as cheese and leftovers.
6 Srotas consist of gross channels, such as the gastrointestinal tract, lymphatic system, veins, arteries, and genitourinary tracts, as well as the subtle channels of the capillaries and the nadis. Nadis may be likened to the meridian (channel) system of Chinese Medicine.
7
Maya Tiwari. Ayurveda: A Life of Balance. (Rochester VT: Healing Arts Press, 1995), 27.8
See: Paul Pitchford. Healing With Whole Foods, Revised Edition. (Berkeley: North Atlantic Books, 1993). Also: Rudolph Ballentine, M.D. Diet & Nutrition: A Holistic Approach. (Honesdale PA: Himalayan Institute Press, 1978).9 A free flow of water through the body is essential to the detoxifying and cleansing activities of the urinary tract, skin and colon. This becomes even more important as we get older and body tissues become drier.
10
Sunil V. Joshi, M.D. (Ayu). Ayurveda & Panchakarma. (Twin Lakes WI: Lotus Press, 1996).11 Oleation is the saturation of the body with herbal and medicated oils, both internally and externally. External oleation vigorously massages medicated oils into the body, where the skin will actually absorb significant amounts of the oil. Internal oleation consists of the ingestion of considerable amounts of herbalized ghee (clarified butter). Over seven days of internal and external oleation, all the tissues of the body are affected – ghee penetrating from the gastrointestinal tract outward towards the skin and medicinal oils penetrating from the skin inward.
12 Since skin absorbs through the pores, oils applied to the skin should always be something you wouldn’t mind eating. Most massage oils tend to be nut or vegetable oils, but care should be exercised to try to use as natural and as food-grade an oil as possible. Mineral oil (baby oil) is a petroleum product and will clog the pores.
13
Harish Johari. Dhanwantari. (Rochester VT: Healing Arts Press, 1998), 36. Also: Melanie Sachs. Ayurvedic Beauty Care. (Twin Lakes WI: Lotus Press, 1994), 178.14
Carl Dubitsky. Bodywork Shiatsu. (Rochester VT: Healing Arts Press, 1997), 228.15
John W. Garvey, N.D., D.Ac. The Five Phases of Food: How to Begin. (Brookline MA: Wellbeing Books, 1983). Barry Kapke is the program director of Asian Bodyworks at San Francisco School of Massage and the founder of Insight Bodywork™. He will be teaching a 7-day residential intensive at Heartwood Institute, August 17-23, 2002. He can be reached via e-mail at insight@bodhiwork.orgCopyright © 2002, Associated Massage & Bodywork Professionals, Inc. All rights reserved. This article is distributed, with permission of the author, for personal use only. It was published in Massage & Bodywork Magazine (June/July 2002). For permission to reprint, please contact: Associated Massage & Bodywork Professionals, Attn: Karrie Osborn, 1271 Sugarbush Drive, Evergreen CO 80439-9766.
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