A Layman’s (Plain English) Discussion and Review of Dr. Thrasher’s Final Publication with Dr. Don Dennis MD, ENT, FACS.
By: Cesar Collado
In Memory of
Dr. Jack Thrasher
Background and Introduction:
Dr. Jack Thrasher, Renowned American Imunotoxicologist passed away early this year leaving a legacy of research and publication advancing the fields of toxicology and environmental illness. He is known for groundbreaking work investigating and exposing environmental toxicities that have had tremendous impact on patients with debilitating toxicities. He dedicated decades to awareness surrounding the toxicity of formaldehyde, pesticides, and mold mycotoxins. His research focused on Mycotoxicity and Multiple Chemical Sensitivity and he has impacted countless patients suffering from environmental toxicities that often elude the diagnosis process in modern medicine.
His final research paper in collaboration with Don Dennis MD, ENT, FACS was published on April 24, 2017 in the Journal of Otalarynology and Reconstructive Surgery, entitled “Surgical and Medical Management of Sinus Mucosal and Systemic Mycotoxicosis.” This paper illustrates the complexity and severity of systemic mycotoxicosis, the challenges with diagnosing toxicities, and the extraordinary efforts required to accurately diagnose and treat the debilitating and potentially deadly systemic infections.
Systemic Mycotoxicosis is often a diagnosis of exclusion given the wide range of symptoms which overlap with many chronic illnesses. This paper details all the processes and challenges of diagnosing and treating the mentioned patients effectively. Research suggests, many human diseases result from exposure to mycotoxins. For the majority of such diseases; however, the epidemiological data establishing a causal link between exposure and disease are lacking.
Mycotoxicosis presents itself as many debilitating symptoms caused by mycotoxins, i.e. secondary metabolites of molds. Exposure to mycotoxins is mostly by ingestion, but also occurs by the dermal and inhalation routes. Mycotoxicosis often remain unrecognized by medical professionals, except when large numbers of people are involved. Epidemiological, clinical and histological findings have only become available in outbreaks of mycotoxicosis. Currently many cases resulting from exposure to home environments with mold are often isolated. They are in-particular, associated with water damaged buildings.
To put this into perspective, I’d like to reference a television show, “House MD”, an award winning medical drama aired from 2004-2012 on the Fox Network. The premise of the show was centered on a CSI-style medical detective program, a hospital “whodunit” by which the ‘diagnostician’ physicians investigated symptoms and their causes. The physicians often broke into patients homes to investigate the living environment searching for clues to aid in the diagnosis and treatment of a severely ill patient. The show was inspired by a column titled “Diagnosis” written in The New York Times Magazine by Yale Physician, Dr. Lisa Sanders who recreates hard-to-solve medical cases. However, the results in these articles often came too late, during post-mortality analysis or investigation.
The patients involved in this paper were seen and treated by several physicians unsuccessfully, prior to diagnosis and treatment of the mycotoxicosis. This review will capture the “House” like process followed by physicians who understand the dangers and challenges of treating patients suffering from mycotoxicosis resulting from environmental exposure to mold and its poisonous secondary metabolites or toxins.
“Surgical and Medical Management of Sinus Mucosal and Systemic Mycotoxicosis”
Journal of Otolarynology and Reconstructive Surgery
April 24, 2017
Don Dennis MD, ENT, FACS, Jack D Thrasher PhD. Immunotoxicologist
The paper features the experience with two patients, women, 26 and 53, exposed to mold in their water damaged homes that presented with sinus and neurological symptoms to Dr. Dennis’s practice. Both patients had seen other physicians and were referred to Dr. Dennis because of his expertise in diagnosing and treating mold related illness due to sinus exposure to fungi.
Patient 1, a 53 year old women had a history of mold exposure in a water damaged building at her work. She had acute exposure due to construction on a wall in 2012 where “hammering” a mold filled wall exposed her to mold, resulting in burning nostrils and trigeminal pain immediately following. (Trigeminal Pain a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. Trigeminal Neuralgia is a form of neuropathic pain that causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode). Her previous physician conducted an MRI which concluded that she had some white matter legions, viewed consistent with microvascular disease for her age. Her immune system blood tests (IgG) showed elevated levels.
Patient 2, a 26 year old women presented with a history of toxic mold exposure due to flooding in her apartment. She was suffering from a sinus infection that had lasted over 2 ½ months and presented nasal airway obstruction, a deviated septum, numerous physical sinus symptoms including ringing in ears, sinus pressure, dizziness, and vocal cord nodules. In addition, other significant physical symptoms included: GI (pain, GERD,bloating ,gas), gynecological (yeast infection, UTIs), Respiratory (shortness of breath), dermatological (skin rashes, uticaria), and neurological/psychiatric (cognitive dysfunction, insomnia, fatigue, irritability, anxiety, and depression.) Patient 2 also had her home air-samples tested by an inspector which found positive mycotoxin which identified numerous fungi including species that yield mycotoxins.
Initial Physician Recommendations:
Dr. Dennis placed both patients on maximum therapy for fungal infection and insisted they immediately be moved into a mold free (safe) environment. Treatment plan included intranasal and oral antifungal medications (Oral antifungal medications are used with caution due to adverse effects, drug interactions, and toxicity and may require periodical blood testing), and a daily schedule of antifungal nebulization, 100% Oxygen treatment, numerous nutraceutical and dietary supplements for liver detoxification, binding to toxins for excretion, and Sinus Defense sublingual spray (transfer factor to support cell mediated immunity).
In addition to testing the clothes of the patients worn during the visit, the patients were asked to collect various surface samples in their homes using petri dishes (SDA agar plates) to capture and culture mold colonies present. The samples were analyzed by a certified laboratory for mold testing.
In addition to the diagnostic results provided, CT scans of the sinuses of both patients were ordered. Both scans revealed evidence of abnormalities requiring surgical intervention. Both surgeries involved access to all 8 sinuses with surgical removal of diseased tissues (where tissue samples were obtained for mycotoxin testing.) The endoscopic surgeries provided unique access to all sinuses of the patients. A significant Amphotericin B irrigation was performed multiple times to eliminate mycotoxins and fungi in all tissues, including the sensitive areas close internally to the eyes and brain.
Both patient’s clothes, nasal cavities, and homes tested positively for excessive numbers of fungal contamination including several species that produce mycotoxins. Identification of mold on the clothes is strong circumstantial evidence that there are mold issues in the patient’s home or automobile. Test were performed throughout the homes and HVAC system in patient 1’s home. Most notable was the clear identifications by the laboratory of fungi in unsafe amounts in the patient’s sinuses and throughout their home including: bedrooms, bedding, furniture, and air.
Mycotoxins were detected in urine of Patient 2. however, this tests provide evidence that is inherently inconclusive. If mycotoxins are detected, the source could possibly be something other than an obvious environmental contamination. For example, low levels of mycotoxins are found in many foods. For that reason, they can be found routinely in urine which make this test an unreliable indicator or of mycotoxicosis poisoning. According to the CDC, there are no FDA approved urine tests for mycotoxins. However, Dr Thrasher recommended and utilized Real Time Labs as “the only laboratory licensed by the College of American Pathology and CLIA for urine mycotoxin tests.” https://www.realtimelab.com/environmental-inspectors/mycotoxin-testing/
Unique to the investigators in these cases, the authors of the paper took samples of tissues and placed them in SDA agar plates and sent to a mycotoxin lab for testing. It is in these samples where positive identification of several dangerous mycotoxins were identified conclusively.
Post operation and home remediation, patient 1 had marked improvement . In addition to sinus relief, her cognitive function went from 1-2 to 8-9 with 10 being normal. Her energy went from 1-2 to 6-7 with 10 being normal.
Patient 2 also had marked improvement after she moved from her apartment.
The earlier reference to the House MD television show was meant to be an analogous to the complexity and challenges to identifying mycotoxins and mycotoxin illness. Medical Protocols are designed to generate conclusive and cost effective diagnosis. Because mycotoxins can cause a wide variety of symptoms associated with many disease states, traditional protocols and medical practices may lead physicians to inaccurate diagnosis.
It is not uncommon for patients suffering from cognitive, neurological, or emotional distress due to Mycotoxicosis to be given an incorrect diagnosis of vague disease states such as depression, chronic fatigue, fibromyalgia, etc. and treated with antidepressants, nerve pain medications (anti-epileptics), and other medications accompanied by referrals to other specialties. This phenomenon prolongs patient suffering and contribute the complexity of diagnosing mycotoxicosis.
Drs. Dennis and Thrasher have unique expertise in mold and mycotoxicosis. It is through this insight that they are able to look beyond the patient and symptoms presented in the office to a patient’s environment. In Dr. Dennis’s specialty, ENT, mold, fungi, and mycotoxicosis are clear possibilities, since through inhalation sinus tissues are exposed first to the antigens. In both cases, the patients disclosed exposure to mold in their water damaged homes. Immune response and mucous production exhibited by the patient provided further evidence of mold as the antigen. In addition, the presence of severe symptoms ranging from sinusitis to neurological disorder raises a red flag that the origin of these symptoms may be significant.
When a physician becomes open to becoming a sleuth, the possibilities of environment illness are considered. Testing the patient for mold on their clothes, nostrils, and homes added critical information to the diagnostic process. While these tests are cost additive, their costs (hundreds) is minimal when compared to the time a patient spends suffering while going from physician to physician, medication and adverse events associated, and other unnecessary diagnostics, which can result in tens of thousands to the health care expenditures. In addition, debilitating illness places significant strain on relationships, career, and financial insecurity. In this case, the authors went a step further to accurately identifying the specific neurotoxins implicated in the debilitating illness. It is also important to note that both patients were instructed to remove themselves from their homes and into a “safe” place until the home can be fixed or they can move altogether. This recommendation was as important as the treatment.
Drs. Thrasher and Dennis have dedicated their careers in helping patients like Patients 1 & 2. This paper shares their approach to problem solving when environmental illness is a possibility and can easily employed by other physicians. The sleuthing regarding the home was productive and informative. Taking advantage of access to the hardest to reach sinuses near the brain and utilizing antifungal medications topically where it is relatively safe to utilize is novel and effective and should be considered by other ENT professionals.
The late Dr. Thrasher spent his career “sleuthing” to identify environmental toxins and he supported significant contributions to society by making the public aware of the toxic effects of formaldehyde, pesticides, and toxins. He collaborated and published countless papers, generously shared his time with many Physicians, Naturopaths, Advocates, and other professionals, for the sake of suffering patients. He challenged traditional medical approaches that refused to recognize environmental illness or carelessly deeming symptoms as psychosomatic.
The Global Indoor Health Network dedicated a special edition to “Remembering Dr. Jack Thrasher”.