Anti-Inflammatory Strategies–Achieving Homeostasis
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This month was the 13th anniversary of the haunting September 11 event that has changed us, our Nation, and the world we thought we knew. It seems like yesterday that these events happened.

Three years ago, I posted my frustration of my inability to get First Responders, and/or their health practitioners, to consider addressing the issue of immune homeostasis, immune balance, to enhance the quality of life of individuals that had put themselves at risk to save others.

 Exposure to Air-Borne Particles

The World Trade Center Health Registry estimates about 410,000 people were exposed to air-borne particles and toxins attempting to rescue survivors and recover the dead, clearing the site, or cleaning the surrounding buildings.

 Despite the fact that early in the World Trade Center (WTC)’ construction, builders abandoned asbestos as a fireproofing material, over 400 tons of asbestos were used in the building of the World Trade Center (WTC). Additionally ”mineral wool”, minerals that were melted and spun into fibers and bound together by cement like components was used in construction.

 Massive amounts of hazardous fiber, asbestos, glass, gypsum, and cement were pulverized into ultra-fine particles when the Towers imploded and collapsed on September 11. Virtually every surface was covered with a fine, white particulate dust, and downwind from the complex, the fine particulate matter settled to a depth of 3 inches or more.

Affected groups of Responders include firefighters, police, health professionals, clean-up crews, construction workers, truck drivers, transit workers, lower Manhattan residents, and office workers.

 Increase Risk of Cancer

Responders were exposed to hundreds, if not thousands, of toxic particulates, dust, and gases at Ground Zero. As many of these are known to be potential carcinogens, it is not surprising that two years ago, 58 different types of cancers were added to a list of diseases with which many World Trade Center responders suffer.

 Overall, First Responders at Ground Zero have a 15% increased cancer risk with a 239% higher risk for thyroid cancers. However, unfortunately, asbestos-related lung cancers such as malignant mesothelioma may not appear for 20-40 more years.

 Signature Illness: PSTD and Respiratory Illness

If having a significant increase in cancer risk was not enough, according to the findings of the Stony Brook [NY] Medicine’s World Trade Center Health Program, as many as 60% of 9/11 World Trade Center responders continue to experience “clinically significant symptoms of post-traumatic stress disorder (PTSD) and … respiratory illness”.

Coughing and breathing problems have been a major issue, even in Responders that were only “moderately” exposed. Additionally individuals with the most exposure were more likely to find that their asthma symptoms became worse.

Benjamin Luft, MD, Medical Director of the Stony Brook Program is of the opinion that “a signature illness” of a WTC Responder is having both PTSD and respiratory problems at the same time.

 Respiratory Difficulties and Inflammation

Inflammatory biomarkers have been monitored in those exposed to WTC dust and smoke. Elevated levels soon after exposure were associated with increased risk of difficulty breathing in the years that followed.

 PTSD and Inflammatory Responses

A few months ago I stated “Clinical studies suggest that individuals with post-traumatic stress disorders suffer from chronic low-level inflammation. This is reflected in their greater propensity to have inflammation-associated diseases such as autoimmune, cardiovascular, gastrointestinal, musculoskeletal, and respiratory diseases.”

 “…individuals with PTSD are more likely to have significantly higher amounts of circulating CRP [an inflammatory marker] than those not diagnosed with PTSD.”

 The Combination of PTSD and Respiratory Issues

To repeat from my previous post,“The immune system mounts an immune, inflammatory response when the body is exposed to pathogens, pollutants, or toxins. The inflammatory cells release immune factors, such as cytokines, cellular messages, that are involved in cell-to-cell communication with the “purpose” of recruiting more inflammatory cells into an area to help eliminate a perceived threat.”

 “Pollutants and chemicals … trigger airway inflammation and increase mucous production. Other immune molecules cause narrowing of airways resulting in the contraction of the muscles lining the airways. The combination of inflammation and increased mucous makes it difficult for air to enter or leave the lungs and can result in breathing issues.”

“Additionally, lungs that do not function properly, are ideal for the multiplication of molds, bacteria, and viruses. The lungs continue their struggle to eliminate pollutants and pathogens, resulting in a chronic, persistent, dry cough and worsened lung function.”

 A Plea to Readers

I am convinced that immune inflammatory imbalances contribute in large portion to the reason that that First Responders experience so many health challenges.

 It is my heart-felt hope and expectation that helping individuals return to immune homeostasis, immune balance, may be the key to changing their quality of life. Despite numerous attempts and avenues, I have been unable to make reliable contact with decision makers or Responders.   I hope that you will forward my note to individuals that are still suffering the consequences of serving others.

 I can be reached at: DrHellen@DrHellenGreenblatt.info or at 302.265.3870. Thank you.

www.asbestos.com/world-trade-center/
sb.cc.stonybrook.edu/news/general/140910wtc.php
911research.wtc7.net/wtc/evidence/dust.html
www.sciencedaily.com/releases/2014/09/140910185910.htm
www.health.ny.gov/environmental/investigations/wtc/health_studies/responders.htm
www.cnn.com/2013/09/11/health/911-cancer-treatment/
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www.mesothelioma.com/blog/authors/barbara/help-running-out-for-911-first-responders.htm
www.ncbi.nlm.nih.gov/pubmed/21998260

Post-traumatic stress disorder (PTSD) occurs in some individuals that are exposed to emotionally disturbing events such as combat, rocket, and terrorist attacks. Individuals that have suffered traumatic brain injury (TBI) or experienced natural disasters and sexual assault are also at higher risk of having this disorder.

Symptoms may include quality of life issues such as explosive outbursts of anger, difficulties in concentrating, being easily startled, feeling constantly “on guard”, expecting a threat to occur at any moment, depression, problems sleeping, avoiding people and circumstances that can trigger unpleasant memories or outbursts, limiting emotional relationships, and avoiding crowded locations.

Up to twenty percent of veterans serving in Iraq and Afghanistan, 10% of Gulf War (Desert Storm), and 30% of Vietnam Veterans have been diagnosed with post-traumatic stress disorder.

PTSD is not only a psychiatric issue. Individuals suffering with PTSD are at higher risk of being physically ill, and at increased risk of death from a multiple of causes.

PTSD is Associated with Inflammatory Responses.
Clinical studies suggest that individuals with post-traumatic stress disorders suffer from chronic low-level inflammation. This is reflected in their greater propensity to have inflammation-associated diseases such as autoimmune, cardiovascular, gastrointestinal, musculoskeletal, and respiratory diseases.

A combination of high blood sugar, cholesterol, and blood pressure, coupled with excess fat around the abdomen (abdominal visceral fat), increases the risk of individuals for stroke, heart disease, and diabetes. This cluster of symptoms, metabolic syndrome, is associated with inflammation and is found in 48% of individuals with post traumatic stress syndrome compared to 25% of controls. Such clinical issues result in patients with PTSD utilizing a greater proportion of medical services and prescription medications.

IL-6 is a cytokine, an immune messenger, which plays a major role in inflammation, helping the body heal after tissue injury, and defending the body from pathogens. C-reactive protein (CRP) is another biological marker that is strongly related to heightened levels of inflammation. Elevated levels of IL-6 and CRP are associated with an increased risk of heart attacks and other cardiovascular events that are inflammatory in nature.

Reports of increased presence of inflammatory cytokines in individuals with PTSD are inconsistent. However, the evidence suggests in military personnel with PTSD or depression, IL-6 levels are higher than found in control subjects, and that the quality of life of these soldiers is poorer as well. Similarly, individuals with PTSD are more likely to have significantly higher amounts of circulating CRP than those not diagnosed with PTSD.

Intermittent explosive disorder is one of the more troubling aspects of some individuals with post traumatic stress disorder. This condition involves repeated episodes of impulsive, angry, verbal outbursts, and violent and aggressive behavior. CRP and IL-6 levels are significantly higher in personnel with intermittent explosive disorder compared with normal or other psychiatric controls, suggesting a direct relationship between inflammation and aggression.

Summary:
Fifty percent of individuals with post traumatic stress syndrome do not seek treatment, and of those that do, only half of these persons will get “minimally adequate” treatment. Until now, the primary treatments for PSTD are psychological counseling and psychiatric medications.

Inflammation is the result of a delicate balance between inflammatory and anti-inflammatory responses, and the body constantly strives to maintain a state of “immune homeostasis”, immune balance.

As in most disease, chronic low-grade inflammation is a likely contributor to post traumatic stress syndrome. If individuals with PTSD better controlled the amount of inflammation produced by their bodies, their quality of life would improve, both emotionally and physically.

 

There is no cost to speak with Dr. Hellen. She can be reached at 1.302-265.3870 ET [USA] or contacted at: drhellen@drhellengreenblatt.info.

 

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It is ten years since the horrific 9/11/01 attacks on the World Trade Center in New York City, The Pentagon in Washington, DC, and Flight 93 in Pennsylvania. On that day at the World Trade Center alone, there were approximately 3,000 murders.

These events have not only left the families, friends, and citizen survivors distraught and at great emotional and financial risk, but the heroic responders, the rescuers, recovery, and clean-up personnel, and civilians that lived and worked in the area, continue to pay a significant price in terms of their health.

There will never be a true accounting of how many individuals were exposed to smoke, thick-coatings of dust, combustion materials, asbestos, polychlorinated biphenyls (PCBs), dioxin, asbestos, and metals. Fire fighters, police, military members, paramedics, construction and iron workers, municipal employees, security workers, residents and workers in the area, and those that came from afar to help, were exposed to these toxic chemicals for days, weeks, and months. Fires burned for 69 days and even eight months after the destruction, workers were still searching for body fragments (1).

For some, the years may be receding from memory, but there are many individuals, and rescue and recovery dogs, that have, or are, still, paying a significant price for their heroic sacrifices. If they are still alive, their emotional and physical health has declined significantly, and no one seems to be able to help them.

Only limited funding has been available to study and monitor individuals that were at Ground Zeroand its surrounding environs. When researching information for this article I was surprised at the relatively few, peer-reviewed publications on this topic, and there is even less information on the effects of this trauma on children and adolescents.

Multiple Health Issues

A primary investigation now led by Dr Juan Wisnivesky, Mount Sinai School of Medicine in New York, has said, “Our findings show a substantial burden of persistent physical and mental disorders in rescue and recovery workers who rushed to the site of the WTC and labored there for weeks and months. Many of these individuals now suffer from multiple health problems (2), since World Trade Center-related mental and physical health conditions often co-exist (3).

Mental Health Issues Persist

One year after 9/11, it was estimated that more than 420,000 people New Yorkers were suffering from post traumatic stress disorders (PTSD) as a result of the attacks (1). This month, the prestigious British journal, Lancet, reports that 32% of tested personnel experienced post traumatic stress disorders and 28% per cent experienced depression at some time after 9/11. The incidence of most of the disorders was highest in workers with greatest World Trade Center exposure (3,4). Other emotional problems such as recurring nightmares, flashbacks, self-medication with alcohol, etc. have also been persistent issues.

Tomorrow: 9/11 Responders: Cancer Risks, Pulmonary Function, Immune Homeostasis, Balance.

1) www.guardian.co.uk/world/2002/aug/18/usa.terrorism

2) www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61180-X/abstract

3) www.guardian.co.uk/world/2011/sep/02/world-trade-centre-rescuers-health-risk

4) www.thelancet.com/journals/lanonc/article/PIIS1470-2045(01)00543-5/fulltext

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