After the Smoke Clears, Keeping Fire Fighters Healthy

Dr. Sara Rodgers, NMDLewiston, ID 2007

What this Presentation is about

• Specific Health Risks for Fire Fighters– Heart Disease– Cancer– Chronic diseases

• Treatment Suggestions– Nutrition– Exercise– Detoxification

• Suggestions for Idaho

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

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%

Cardiovascular Disease

CVD: cardiovascular diseaseCHD: coronary heart disease

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.

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.

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

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.

Environ. Health 2003; 2-14.

CVD deaths increase over trauma deaths after 6 pm.

Circadian Rhythm Risk

Cardiovascular Disease Deaths Compared to the General Public

Environ. Health 2003; 2-14.

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)

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

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

Cardiovascular Disease Death Risk Factors

Individual predictors • > 45 years old• Hypertension • Smoking• Previous diagnosis of CHD

Other risk factors• Diabetes• Hypercholesterol (cholesterol > 200)

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

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

Cancer

• Fires expose fire fighters to a variety of chemicals and substances

• There is associated incidences of cancers with these exposures

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

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

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

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

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

Exposures give carcinogenic risk

• VOC’s found in highest concentrations have high toxicity and carcinogenicity – particularly benzene, 1,3-butadiene, and

styrene

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

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

AntimonyArsenicBismuthBerylliumCadmiumLeadMercuryPlatinumNickelThallium ThoriumTin TungstenUranium

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

Positive Changes

Not everything is about death, chemicals, and heart attacks!

What can be done

• Prevention– Proper monitoring– Nutrition– Physical Fitness programs

• Detoxification– Chemicals – Heavy metals

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.

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!

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

Regular Check ups

• Monitoring of baseline physical fitness

• Cardiovascular fitness• Pulmonary fitness• Body Mass Index• Cancer Screenings

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

NVFC Heart Healthy Firefighter Program

• A national program recognizing the cardiac risk of volunteer firefighters

• http://www.nvfc.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.

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/health/public/heart/hbp/dash/new_dash.pdf

• The need of “color” in our food and real foods: color of the rainbow every day.

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

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

Adaptation• How do we make the

foods that we love healthier?

• Do I have to eat fruits and vegetables? – YES

• Recipe adaptation – simple changes

Recipe AdaptationCourtesy of Melanie Spooner, BSc Nutrition

Making healthy changes to some old stand-bys

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

Example of Adapted recipe: Southern Breakfast Casserole

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 3rd 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

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.

Detoxification

• First three ways to reduce toxins– Avoidance– Avoidance– Avoidance

• Nutritional supplementation• Sauna• Colon Hydrotherapy• Gentle exercise

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

Detoxification with Hubbard Protocol

• Gentle exercise followed by Sauna 140-180 0F 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

Hubbard ProtocolFree 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

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

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

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

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

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)

Applying a Health Model to Idaho

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

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.

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.

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.

Thank you for attention

Sara Rodgers, NMDBoise Natural HealthBoise, ID 83706www.boisenaturalhealth.com208-338-0405