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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

Severe nasal reactions to medications, pollen, dander, foods, fragrances, and other environmental stimuli may occur as people age. These responses, often not a true allergic response, are termed vasomotor or nonallergic rhinitis (1), because they are not due to a typical “allergic” response.

Nonallergic rhinitis (“itis” as in inflammation) is associated with increased irritability, problems in focusing, sleep issues, and daytime sleepiness. Also individuals with rhinitis are at higher risk of getting asthma (2).

Hallmarks of nonallergic rhinitis include inflamed sinuses, drippy, congested nose, chronic sneezing or coughing. Nonallergic rhinitis is seen when inflammation occurs in the sinuses of the face, and the nasal membranes and blood vessels in the nose expand filling the lining of the nose with blood and fluids.

According to the Mayo Clinic specific triggers for nonallergic rhinitis also include (3):

Infections: Viral infections can result in nonallergic rhinitis due to postnasal drip and nasal discharge. Facial pain and sinusitis (inflammation and pressure in the sinus cavities of the face) may also be an unwelcome outcome.

Medications: Overuse of decongestant nasal sprays can cause rhinitis as can medications such as sedatives, beta blockers, antidepressants, oral contraceptives, erectile dysfunction drugs, blood pressure medications, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Environmental: Strong odors, such as perfumes or cleaning fluids, smoking, secondhand smoke, dust, can become a cause of nonallergic rhinitis.

Foods and beverages: Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.

Weather: Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose. Dr. Rohit Katial, Director of Adult Allergy and Immunology at National Jewish Health, Denver, CO states “Even cold air becomes more problematic as we get older” (1).

Stress and Exercise: Stress and exercise have been shown to induce inflamed sinuses.

Hormonal changes: Changes in hormones due to menstruation or pregnancy, or a autoimmune hormonal conditions.

The majority of inflammatory illnesses result from over production of pro-inflammatory (inflammation enhancing) cytokines, and other immune cellular factors. Our survival on earth depends on the ability of the body to rapidly generate appropriate inflammatory responses to “burn out” pathogens that threaten to destroy us.

The body must be able to modulate the amount of inflammation produced and decrease its intensity as the challenge is met. The key to health is immune homeostasis. We must generate enough of an inflammatory response to meet the threat, but in controlled amounts so that bystander tissues and organs are effected.

1) http://online.wsj.com/article/SB10001424053111903480904576510302458640840.html
2) http://emedicine.medscape.com/article/874171-overview
3) http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809/DSECTION=causes

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