1. After the Smoke Clears, Keeping Fire Fighters Healthy Dr. Sara Rodgers, NMD Lewiston, ID 2007

2. What this Presentation is about Specific Health Risks for Fire Fighters –Heart Disease –Cancer –Chronic diseases Treatment Suggestions –Nutrition –Exercise –Detoxification Suggestions for Idaho

3. Fire fighters have one of the highest rates of mortality for any profession in the US. Stress Hazardous Working Conditions Environmental Exposures Disease Predisposing Factors

4. The Hidden Risks Between 1977-2002, coronary heart disease (CHD) accounted for 45% of on-duty fatalities Stress may play a large factor in these deaths, but when compared to comparable stressful professions, firefighters have a larger risk of heart-related deaths. –Firefighters: 45% –Policeman: 22% –Other EMS professionals: 11% –Occupational fatalities overall: 15%

5. Cardiovascular Disease CVD: cardiovascular disease CHD: coronary heart disease

6. Heart Disease 48% of deaths of active fire fighters are attributed to cardiovascular disease Fire suppression accounted for 36% of coronary heart disease deaths, but fire suppression may only represent 2% or less of a firefighter's yearly duties. Firefighters with 30 years on duty have increased rates of cardiovascular disease aortic aneurysms.

7. Potential reasons for on-duty cardiac disease related deaths Pulse rate goes up with alarms and sirens Physical burden of wearing 50+ pounds of protective equipment while working near maximal heart rates Heat stress and fluid loss can cause decreased cardiac output even with increased pulse Personal protection devises reduce environmental toxic exposure, but does not eliminate all toxins.

8. Volunteer risks Volunteers may not be required to stay in physical shape or get yearly physicals Both professional and volunteer health risks –Long sedentary periods followed by heavy exertion –Shift work

9. Study of 52 Coronary Heart Disease Deaths Most emergency calls occurred between noon and midnight. This was also the time when most firefighter trauma deaths and coronary heart disease deaths occurred. This pattern occurred with both 24-hour shift work for professional firefighters and volunteer fire fighters.

10. Environ. Health 2003; 2-14. CVD deaths increase over trauma deaths after 6 pm. Circadian Rhythm Risk

11. Cardiovascular Disease Deaths Compared to the General Public Environ. Health 2003; 2-14.

12. General Population: Monday morning heart attack General population has higher risk of Coronary Incidents in the morning because: –Increased arterial blood pressures –Increased platelet aggregation (increased clotting) –Increased serum cortisol (stress response hormone) –Increased catecholamines (stress response hormones)

13. Emergency Response 60 times the risk of CHD death over non emergency-duty Similar factors as the general public MI Increased blood pressure at onset of alarm Loud sirens can cause increased blood pressure Increased demands on the cardiovascular system The Evening Heart Attack

14. Physical Fitness Strenuous training drills were a source of CHD deaths for firefighters lacking physical fitness Most fire departments do not require regular exercise. In one study 33% of fire fighters were measured as obese with this figure increasing to 40% four years later

15. Cardiovascular Disease Death Risk Factors Individual predictors > 45 years old Hypertension Smoking Previous diagnosis of CHD Other risk factors Diabetes Hypercholesterol (cholesterol > 200)

16. Study Conclusion Most on duty coronary heart disease deaths are work precipitated These deaths occur to fire fighters with underlying CHD risk factors The death incidences occur with increase in emergency calls Strenuous activities associated with fire fighting work is associated with CHD deaths Fire fighters without CHD risk factors are unlikely to suffer from CHD death

17. Falling through the cracks Most of the CHD death firefighters did not have a fire department medical exam 2 years prior to death incident Many rural fire departments are volunteer based. Many of these individuals have other jobs that may not require physical activity

18. Cancer Fires expose fire fighters to a variety of chemicals and substances There is associated incidences of cancers with these exposures

19. Cancer Risk Firefighters are twice, sometimes three times as likely, to develop testicular or skin cancer and leukemia. Brain cancer in firefighters with 20 years of experience is so common in Ontario, Canada that it is recognized as a workplace injury and victims are automatically compensated. At least 15 studies show a statistical link between brain cancer and firefighting

20. Cancer continued Elevated mortality risks for brain tumor, cancers of lymphopoietic, bladder and kidney, and soft tissue sarcoma have been observed The overall risk of cancer among firefighters was significantly higher when compared to the general Florida population. Significant excess mortality observed for respiratory cancer and skin cancer. Cancers may not appear until later in life

21. Cancer Brain cancer –Of the 14 major studies of firefighters' mortality, which gave findings for brain cancer, 11 found some excess risk. Formaldehyde, benzene, vinyl chloride, acrylonitrile Leukemia –Statistically significant elevation leukemia in firefighter with >30 years of service –Potential causative agents include benzene, soot and polycyclic aromatic hydrocarbons (PAH’s), vinyl chloride, acrylonitrile, formaldehyde

22. Cancer Colon Cancer –Statistically significant increases in colon cancer were identified in three studies. –Asbestos, PAH’s, acrylonitrile and formaldehyde Bladder cancer –Increased incidences of bladder cancer among fire fighters. –Some evidence of dose response

23. Types of cancer and exposure A 2001 study of 9 municipal fires under conditions where firefighters would probably remove self contained breathing apparatus –Benzene, toluene, napthalene dominated –Propene, 1,3-butadiene found in all fires –Styrene, alkyl-substituted benzenes frequently found –76 % of all VOC’s measured: Propene, benzene, xylenes, 1-butene/2-methylpropene, toluene, propane, 1,2-butadiene, 2-methylbutane, ethylbenzene, naphthalene, styrene, cyclopentene, 1- methylcyclopentene, isopropylbenzene

24. Exposures give carcinogenic risk VOC’s found in highest concentrations have high toxicity and carcinogenicity – particularly benzene, 1,3-butadiene, and styrene

25. Self Contained Breathing Apparatus (SCBA) One study found that fire fighters only used their protective breathing devices for 50% of time at structural fires and only 6% of time for all fires. Urine tests confirmed exposure to VOCs at site

26. Heavy Metals “Heavy Metals should be measured as regularly as cholesterol” (Dr Rita Ellithorpe, MD) Blood test only tell current exposure Provoked urine test will indicate some level of body burden Antimony Arsenic Bismuth Beryllium Cadmium Lead Mercury Platinum Nickel Thallium Thorium Tin Tungsten Uranium

27. Why measure heavy metals Most likely, we all have heavy metals –Cigarettes, leaded gasoline (1973), pesticides, foods, air, water, hobbies (lead bullets, stained glass) Heavy metals affect the body in significant ways –Endocrine (hormones), immune, cardiovascular, gastrointestinal, neurological systems –High blood pressure, neuropathies, brain function Heavy metals aggravate other disease conditions

28. Positive Changes Not everything is about death, chemicals, and heart attacks!

29. What can be done Prevention –Proper monitoring –Nutrition –Physical Fitness programs Detoxification –Chemicals –Heavy metals

30. Prevention Preventing disease costs a lot less than treating chronic disease 2002. American Diabetes Association approximates $132 billion was spent on direct medical and indirect expenditures. 2006. American Heart Association and National Heart, Lung, and Blood Institute estimate the cost of cardiovascular disease and stroke to be $403.1 billion.

31. Ability to heal Unless a disease has created permanent organ damage, most people can reverse the disease process Cardiovascular disease is preventable and reversible! Diabetes type II is preventable If one already has diabetes and is not reliant on insulin, they can stay that way with proper exercise and nutrition!

32. Healing is Not Drugs Health program must be multi factorial –Nutrition: Healthy Food Choices –Supplementation –Detoxification Using pharmaceutical drugs to treat high cholesterol or high blood pressure does not treat the cause of disease

33. Regular Check ups Monitoring of baseline physical fitness Cardiovascular fitness Pulmonary fitness Body Mass Index Cancer Screenings

34. Heart Healthy Suggestions Physical Fitness requirements for recruits and current fire fighters Annual monitoring of physiological parameters (ie, cardiac risk assessment) –Cholesterol and other cardiac parameters –Cardiac stress tests A recent study indicated that abnormal stress tests were highly predictive for cardiac deaths in asymptomatic patients Nutritional counseling Reduction in risk behaviors: i.e., smoking, junk food Stress reduction techniques

35. NVFC Heart Healthy Firefighter Program A national program recognizing the cardiac risk of volunteer firefighters http://www.nvfc.org http:// www.healthy-firefighter.org/http:// www.healthy-firefighter.org/ This is a good start, but a comprehensive program supervised by a MD, DO, or NMD would be preferred.

36. Decreasing Hypertension with Food (courtesy of Melissa Spooner) Associated with balance of minerals Implementation of the “DASH” Diet ( Dietary Approaches to Stop Hypertension ) http://www.nhlbi.nih.gov/hea lth/public/heart/hbp/dash/ne w_dash.pdfhttp://www.nhlbi.nih.gov/hea lth/public/heart/hbp/dash/ne w_dash.pdf The need of “color” in our food and real foods: color of the rainbow every day.

37. Nutrition Nutrition is the cornerstone to any healthy regime. Whole foods, not processed Organic if possible Essential Fatty Acids (ie, wild Alaskan Salmon) Eating Breakfast, Eating protein with Breakfast Reducing sugar, caffeine, partially hydrogenated oils

38. Food vs Medication 1 month of Lipitor For 10mg daily dose $65.00+ 1 month supply of quality omega 3 fatty acids $30.00/bottle

40. Adaptation How do we make the foods that we love healthier? Do I have to eat fruits and vegetables? –YES Recipe adaptation – simple changes

41. Recipe Adaptation Courtesy of Melanie Spooner, BSc Nutrition Making healthy changes to some old stand-bys

42. Southern Breakfast Casserole Original 18 whole eggs 9 slices wonderbread 2 lbs pork and beef sausage links 9 slices American cheese Adapted 4.5 cups egg beaters 9 slices sourdough bread 2lbs turkey sausage 9 slices low fat/low sodium cheese 1 cup red pepper 1 cup cherry tomatoes 1 cup mushrooms 3 cloves garlic

43. Example of Adapted recipe: Southern Breakfast Casserole

44. Suggested Basic Supplementation Multivitamin –Not one a day, usually 4-8 needed of a good vitamin –Choose one with no colors, sugar, least amount of “other ingredients” Fish Oil: very healthy for the heart –Make sure 3 rd party tested for contaminants Other healthy choices –Vitamin E: 500 IU d alpha tocopherol (not dl alpha), with mixed tococopherols –Magnesium: citrate form better than oxide form Magnesium stearate not a dietary magnesium –Vitamin C: 1-3 grams daily

45. Physical Exercise Daily is good idea At least 3-4 times a week of combined cardio fitness and weight training. Speak to medical professional before starting program if not already exercising.

46. Detoxification First three ways to reduce toxins –Avoidance Nutritional supplementation Sauna Colon Hydrotherapy Gentle exercise

47. NYC Firefighters NYC September 11, 2001 exposed Fire fighters, other emergency workers, and residents to unprecedented levels of toxins. Many exposed people are suffering from multiple organ system dysfunction –Persistent lung syndromes, cognitive changes, gastroesophaegeal reflux disease, respiratory cancer, other cancers PTSD is also commonly diagnosed: depression, anger, low motivation

48. Detoxification with Hubbard Protocol Gentle exercise followed by Sauna 140- 180 0 F for 2½ -5 hours daily Nutritional supplementation with emphasis on niacin (nicotinic acid) –Also Vitamin A, D, C, E, B complex, B1, minerals –Diet rich in Omega 6 oils Following data reported in Townsend Letter April 2006, #273

49. Hubbard Protocol Free treatment funded by private donations September 2002 484 cases: 273 firefighters, 52 sanitation workers, 19 paramedics, 23 police officers, 117 others 7 days a week, average of 33 days (range 23- 106 days) Physician monitoring, individualized care Tracked range of symptoms: skin, cardiac, respiratory, neurological, emotional, cognitive, gastrointestinal, musculoskeletal, immunological, endocrine

50. Hubbard Protocol Success All participants reported improvement in subjective symptoms All participants reported in perception of health 84% reported decreasing from up to 16 meds to zero. 7% people had one remaining medication Over ½ of participants initially required multiple pulmonary meds to achieve near normal lung function. –At completion, 72% of these people were off drugs and continued to improve lung function

51. Hubbard Protocol Success Thyroid function tests improved Cholesterol measurements improved Intelligence quotients and choice reaction times improved. Balance Quality of live improved: fear of no longer able to work abated. PTSD symptoms alleviated

58. Heavy Metals Getting rid of Heavy Metals includes chelation: EDTA, DMSA, DMPS Needs to be done with experienced practitioner Nutritional supplementation is necessary during the process Can take 1-2 years and then periodically

59. Phoenix Fire Department Health Center Medical director, physicians, physician assistant, nurses, x-ray technician IAFF-IAFC Wellness Initiative Baseline fitness and annual evaluations –Aerobic Capacity –Trunk Flexability –Muscular Strength –Muscular Endurance Pulmonary Function Testing EKG treadmill stress test Hearing and vision evaluation Cholesterol/blood pressure check Blood and urine analysis Radiology Toxic exposure, heat exposure, infectious disease exposure management Contracts to surrounding fire departments to offer physical exams

60. Naturopathic Care At PFD Comprehensive intakes Blood work as indicated Hormone panels Food Allergy/Sensitivity Testing Heavy metal tests and appropriate chelation Diet Evaluation Coaching Professional Grade Nutritional Supplements Botanical medicines and homeopathy Acupuncture Intravenous nutritional procedures (not available in Idaho at this time by Naturopathic Physician)

61. Applying a Health Model to Idaho

62. The Volunteer Factor 85% of Idaho fire districts are volunteer based or volunteer combined with professional This presents an interesting challenge to maintain health standards A mechanism needs to occur to ensure health of both professional and volunteer fire fighters

63. If not already in place Professional hiring standard: Candidate Physical Ability Test (CPAT). Hire from a diversity of community rather than decrease standards Annual stress tests, pulmonary function tests, cardiac risk blood tests (going beyond cholesterol), BMI Reminders of why SCBA equipment necessary: reduced exposure = reduced cancer risk Specific Dietary suggestions. Healthy menus emphasized by the state association and distributed as a resource to departments.

64. Volunteer suggestions Guidelines for volunteers for physical fitness and laboratory achievement levels Education of licensed medical practitioners in volunteer department areas of how to monitor volunteer fire fighter health –This would involve creating community partnerships with health practitioners Create competition and recognition for healthiest departments.

65. Fire Fighters Deserve the Best You Fire Fighters risk their life and health to protect the public. Fire fighters deserve the best preventative medical care, education, and support to reduce job-related cardiovascular deaths. Preventing cardiovascular disease, diabetes, and other chronic diseases can be done.

66. Thank you for attention Sara Rodgers, NMD Boise Natural Health Boise, ID 83706 www.boisenaturalhealth.com 208-338-0405