Authors: Donna Jackson Nakazawa
What is propelling this epidemic? Scientists the world over agree that the root cause of this frightening trend is environmental. Twin studies elucidate that two-thirds of the risk of developing autoimmune disease is acquired through some environmental trigger, genetic risk being the smaller part of the equation. Over the past decade, labs around the globe have proven definitive links between a list of commonly used industrial-age chemicals, heavy metals, and toxins and the development of numerous autoimmune diseases. As hundreds of industrial byproducts interact with the immune cells of our bodies, they are sabotaging an extraordinarily complex and fine-tuned blueprint for healthy cellular communication. Facing a dismal picture in which the numbers of people afflicted with autoimmune disease in industrialized countries continue to rise, the race to turn the tide of this worldwide trend has become a race against time.
This book explores this scientific race—the watershed discoveries that are revolutionizing our understanding of the way the immune system functions and the complex, interlocking factors that cause it to go haywire; what role genes and environmental toxins play in who will be struck by disease; why scientists now believe that even people who are
not
genetically predisposed to autoimmunity may fall ill with these diseases; the groundbreaking interventions emerging out of today’s top labs that promise to help halt the disease process; and ways in which we can each lessen the multitude of exposures that threaten our immune systems and our health.
Four decades ago, writer Rachel Carson, author of
Silent Spring,
demonstrated how our chemical age has altered our environment to the degree that the fertility and survival of many of the species with which we coexist are threatened. Then, as now, there is great resistance to the idea that environmental contamination can alter the health of both animals and people. Indeed, it has taken several decades for many researchers in the autoimmune-disease field to come to the conclusion that our contaminated environment is causing the human immune system to run amok. But the consensus is rapidly building. These pages lay bare this “inconvenient truth”—one as disturbing to today’s top scientists as global warming. My hope is that the chapters you are about to read will awaken a deep understanding about how the environmental changes of the industrial age and our twenty-first-century lifestyles are wreaking havoc with the immune cells of our own bodies.
We
are
our environment. What we put into it, we also put into ourselves. What we do to it, we also do to ourselves. The way in which our bodies are turning against themselves when autoimmune disease strikes serves, sadly, as a disturbing modern analogy for what we are doing to ourselves as a society as we continue to dump thousands of chemicals into the soil, water, and air that surround us. Our mass dependence on chemically manufactured home and lifestyle products and our diet of chemically processed foods, in many ways, constitute a great societal health experiment, as we continue to surround ourselves with thousands of chemicals whose properties we do not yet fully understand.
With our eyes open to that knowledge we can begin to make critical and profound choices, embarking on a journey of small steps that will slowly start to make all the difference between health and disease. As we educate ourselves about the consequences of our day-to-day lifestyles and strive to make the personal, political, and economic choices to counter those ill effects, we will be taking back our environment, our bodies, and our future.
B
etween them, Jan Pankey and David Calhoun shared four decades of experience as physicians. Yet in the quiet dark of one August night in 2003, all that experience seemed to count for nothing. Something was going terribly wrong inside Jan’s body, and neither husband nor wife could make sense of what was happening, or why.
It was shortly after midnight on the first night of a long-anticipated vacation in Montana when Jan awoke to a burning ache that encircled her upper chest. It was all she could do to draw in a breath. If Jan hadn’t known better she might have thought she’d been pummeled with an iron rod across both front and back while she slept. Fumbling in the pitch black of their Idaho hotel room, where they had stopped en route to their final destination, Jan switched on the bedside lamp and stood for a moment in the circle of reassuring yellow light. Her legs felt unsteady. She couldn’t feel the carpet beneath the soles of her feet. It took a blink or two for her mind to register that she was about to faint.
A minute later Jan came around to find herself staring at the coarse hotel rug, struggling to take in a full breath—trying to piece together where she was and why her upper body was in so much pain. In that split second every nerve ending inside Jan Pankey’s body stood on full alert, signaling that something ungodly was happening. She crawled to the bed to wake her husband.
David quickly shook off sleep along with his bewilderment as to why his wife of twenty-eight years suddenly was writhing uncontrollably beside him—in a hotel room a thousand miles from home and an hour from the nearest metropolitan hospital. Together they struggled to diagnose. Jan and David were well versed in the medical school mantra “When you hear hoofbeats, think horses, not zebras,” and so they stuck to Jan’s prior, known medical history rather than coming up with exotic could-be’s. Recently, Jan, who was forty-nine, had started taking birth-control pills to help even out hormonal fluctuations and irregular periods. But that seemed of little consequence here. She’d also been plagued by bouts of indigestion, which her doctor had chalked up to gastritis, a chronic inflammation of the stomach and intestinal tract, due to a fairly common condition known as gastroesophageal reflux disease, or GERD. In GERD, the stomach overproduces gastric acid and the esophagus spasms, causing excess acid to rise into the fragile lining of the throat. It can be quite painful.
Jan and David concurred that Jan must be experiencing spasms in her esophagus due to her GI problems. David felt that Jan’s asthma must be acting up, too; recent forest fires had plagued Montana’s wooded areas and some neighborhoods, and the noxious smoke clouds had grown closer and more visible as the couple had neared the Idaho-Montana border. Still, severe chest pain was not usually indicative of asthma. Could asthma coupled with esophageal spasms produce so much pain? That was their best educated guess at one o’clock in the morning in the middle of nowhere.
Jan and David had left home early the day before with the goal of cycling more than a hundred miles of Montana’s Glacier National Park, an expedition they had spent the past year planning. Jan had been feeling well enough—you’d certainly never know that she suffered from any health issues to look at her. Slim and vitally active in the middle of life, she had already biked more than 3,300 miles in the previous twelve months. She held down a demanding professional schedule, commuting by plane from rural New Mexico to downtown Oakland, California, every two weeks to work long hours as a pediatric and neonatal anesthesiologist at Oakland’s Children’s Hospital. She was also a regular team member on physician-run medical missions overseas, helping children in third-world countries obtain lifesaving operations they might never otherwise receive.
The first night after departing for their big Montana trip—fourteen hours in the car after they’d left behind the rural farming village where they lived near New Mexico’s Rio Grande—the couple had stopped at their Idaho motel just shy of the Montana border. Once settled in their room Jan and David had turned on the air-conditioning to help filter out the polluted soot from the smoking Montana fires that had drifted in behind them and hoped for a good night’s rest. It was a few hours later that Jan’s chest pain suddenly and inexplicably set in.
Then, just as unexpectedly, a few hours before dawn, the wrenching pain began to lift. Jan could take in a deep breath again. She told David she was feeling some relief. David felt reassured by Jan’s slowly returning calm. He would later realize that it was a veneer Jan had perfected all too well after decades of reassuring parents with critically ill infants and soothing children who were about to undergo surgery.
That morning they crossed the border into southern Montana, where ash from the fires hung so thick in the air that you couldn’t see across the street. Neighborhoods were being evacuated. As they got out of their Legacy station wagon to stretch their legs and survey the situation, Jan was seized again by debilitating chest pain and shortness of breath. She dropped to a crouch, gasping for air, unable to stand up.
Half an hour later David was wheeling Jan into the local hospital in Missoula. The emergency-room doctor reassured them that Jan’s X-rays looked fine, except for a small, barely distinguishable anomaly: a slight shading along the lungs above the left half of her diaphragm, deemed insignificant. The doctor surmised that Jan’s discomfort—and she was now twisting in pain on the hospital gurney—might be a kidney stone. Urinalysis ruled that out. Nor was Jan displaying signs of wheezing. The ER doctor, stumped, concluded that Jan and David’s initial hunch had to be right: Jan was suffering from severe spasms in her esophagus due to her gastroesophageal reflux disease. In addition to the spasms themselves, Jan was experiencing muscle strain caused by the spasms along her chest wall. Or so the doctor thought.
The ER physician ordered an intravenous drip to be inserted in Jan’s right forearm and dosed her with Demerol for pain as well as a sedative to help her relax. Afterward, Jan was given Prilosec for her gastritis and reflux, and was released. She felt she could and should go on with the trip.
Jan explained her feelings to David. “We’ve paid the money,” she told him. “And I don’t want to waste an opportunity we’ve been looking forward to all year because of stomach problems.” Beneath her words David heard Jan’s characteristic determination not to be a “wimp.”
By the time the bike tour began later that afternoon, Jan wasn’t so game, and she stayed behind at the hotel. But when the riders headed out again the next morning, she was resolute: she would ride the “sag wagon”—for lagging bikers—up the mountain a thousand feet, then coast down on her bike so that she could see the stunning vistas of glacier and rock she had driven so far to view. She was a veteran biker; what in the world could happen to her as she coasted down a mountain road? She donned her bike jersey, choosing one that would turn out to be all too fitting. Her jersey material was dotted with small red blood cells and sported the logo of the whimsical company that had made it, the Republic of Anaerobia—literally meaning “the state of insufficient oxygen.” Beneath the logo were the words
Veni Vidi Vomiti.
A twist on Julius Caesar’s
“Veni, vidi, vici”
(“I came, I saw, I conquered”),
Veni, vidi, vomiti
was a hardcore no-sissy bike-til-you-drop insiders’ joke: “I came, I saw, I vomited.”
Jan began her glide down the mountain only to find that smog drifting from the fires nearly obliterated the view of the icy gorges and glaciered valleys. But that would turn out to be the least of Jan’s worries. She had coasted another half mile in her red jersey when the now familiar vise of pain returned with a vengeance, nearly jolting her from her seat. She found it hard to pull in a breath. The scenery grew blurry. Colors turned to shades of black and white. She was close to passing out.
David discovered Jan crouched by her bike alongside the narrow mountain pass. All they could think of was getting back to the Albuquerque, New Mexico, medical center near their home where David was on staff, as fast as he could drive them.
Meanwhile, neither of them had a clue that in their empty pink adobe house near the Rio Grande the phone was ringing over and over again as the Missoula hospital’s radiologist—who had finally reviewed Jan’s X-rays—tried in vain to locate the couple.
They were halfway home—still assuming the pain was due to a wicked combination of reflux and gastritis—when Jan noticed a new problem. A hot, angry red line was moving up the vein in her right arm from where her IV needle had been. As a physician she knew a blood clot on sight. She knew that if it progressed it could easily block the flow of oxygen to her heart or lungs, causing a heart attack or even a life-threatening heart infection known as endocarditis. Jan took a dose of the antibiotics that she and David always carried in their first aid kit when traveling, and they stopped at a pharmacy for a heating pad to wrap around her arm to help disperse the clot—both standard protocol. They passed a road sign pointing to a local hospital along the deserted highway. David looked at Jan questioningly.
She shook her head no. “I want to get home to medical care I know we can count on,” she told him. With Jan’s eyes locked on the crimson line to make sure it wasn’t progressing, they headed home.
Eight hours later Jan Pankey lay prone on a gurney inside the Albuquerque Regional Medical Center ER in severe pain, breathing through an oxygen mask while a technician performed a scan of her chest. Jan watched from across the X-ray room as the picture of her lungs began to register on the machine. She didn’t have her glasses on, but even so she could see the clots as they appeared on the scan. The technician stared at the screen in stunned silence, then turned to Jan and said, “Honey, I don’t think you’re going anywhere tonight.”
The X-ray was startling. It looked as if someone had taken inch-sized bites out of several areas of each lung. Blood clots, or pulmonary emboli, had proliferated out of nowhere. Large clots were blocking several large arteries. Three of the five lobes in Jan’s lungs weren’t getting any blood at all, while the other two had been damaged by smaller clots. Together, clots had cut off 50 percent of the oxygen flow to Jan’s lungs. The state of anaerobia indeed. It was a wonder Jan was still alive.
The ER physician on call later explained to Jan and David that the area above Jan’s diaphragm that had appeared tinted in that first Missoula X-ray had been, no doubt, the first lung tissue to be injured.
The red line on Jan’s arm hadn’t progressed, so clearly the clots weren’t originating from there. Additional ultrasounds revealed, however, that Jan’s entire right leg vein was blocked from ankle to groin with a huge clot known as a deep vein thrombosis, or DVT. It was from this larger clot that smaller ones were traveling up to block the major arteries of her lungs. From torso to toes, Jan’s blood was clotting up like sludge and no one could explain why.
Without knowing exactly what was causing Jan’s condition, the ER physicians put her on the blood thinner Coumadin with the understanding that she would need to stay on it for several months to avert further crises. She stayed six days in the hospital before being discharged. But the second day home it didn’t seem to matter that she was taking the full recommended dose of anticoagulants. Jan bent over to pick up a leaf that had fallen from a neglected plant in their foyer and felt “a hard thunk” in her chest that nearly toppled her. She called 911 and David, who was fifteen minutes away at work. The twenty-minute ride alone to the hospital in the back of the ambulance was terrifying.
“Even though I was wearing an oxygen mask I was gasping for every breath,” Jan recalls. When David met the ambulance crew at the hospital, they confirmed what he already feared. Jan’s situation was deteriorating.
The hospital was so full that day that they turned a U-shaped, curtained area of the emergency room into a temporary critical care unit to treat Jan. Kwaku Osafo-Mensah, a young lung specialist from Ghana who’d come to Albuquerque five years earlier after medical training at UCLA and Stanford, was rushed in to consult on Jan’s case. Drawing the beige hospital curtains closed around her makeshift room in the busy ER, Osafo-Mensah quickly explained to Jan and David that even though Jan had been on blood thinners, X-rays showed that she had lost two
more
areas of lung. Her EKG had as many spikes and valleys as the Swiss Alps. Jan and David were terrified.
It was as if someone had punched a hidden self-destruct button inside Jan’s lungs and there was no shutoff switch to be found. She knew that if they couldn’t stop the clots from forming, she would lose all the pathways by which oxygen entered her bloodstream. What was unfolding inside her body was petrifying; it was as if she were being suffocated to death by her own blood cells.
Osafo-Mensah shook his head as he talked to his new patient, trying to nudge the pieces together. Jan’s first embolisms had developed during a long, two-day car ride to Montana. And she was often sitting on airplanes commuting from New Mexico to Oakland. Perhaps both sedentary activities had led to exacerbated clotting. On top of that, anesthesiology is a pretty sedentary job, he explained to Jan. Still, it didn’t add up. Not for someone like Jan Pankey who biked 150 miles a week.
Regardless of the diagnosis, Osafo-Mensah knew what he had to do if he was going to save Jan’s life, and he knew there wasn’t much time. He decided to immediately place a filter in the vein at the top of Jan’s leg, known as the inferior vena cava, which pumps blood up from the lower two-thirds of the body. The filter would stop any clots before they traveled up to Jan’s heart or lungs. That, along with an intravenous infusion of the blood thinner heparin, would prevent more clots from rising toward her lungs.