Shorts

briefed by Jule Klotter

Chemical Sensitivity Treatment Barriers

People with multiple chemical sensitivities (MCS, also known as chemical hypersensitivity, environmental illness, and sick building syndrome) must contend with treatment barriers that people with more widely understood illnesses do not. Everyone knows that germs can cause illness, but only a minority understand that human-produced chemicals can disrupt numerous biochemical processes, creating a diverse range of symptoms. If these symptoms, these warning signs, are misinterpreted or ignored, debilitation eventually results when patients continue to expose themselves to triggering chemicals. Chemical sensitivity is more common than most practitioners realize. A 1999 California Department of Health Services epidemiological study reported that 15.9% respondents to a state-conducted medical survey reported sensitivity to common chemicals, according to Caress and Steinemann.

One major hurdle to successful MCS treatment stems from practitioner ignorance. Pamela Reed Gibson and Amanda Lindberg at James Madison University used a survey to gather information about physicians’ awareness of MCS. They mailed the survey and one follow-up reminder to a random sample of 1000 practicing physicians in Virginia. The Virginia State Medical Association forbade them from handing out the survey at the group’s annual meeting because “[the women’s] research was ‘not consistent’ with the goals of [the] meeting.” Ninety physicians responded to the survey. The authors speculate that the low response rate may be a reflection of MCS’s “marginalized” status in mainstream medicine.

Gibson and Lindberg queried physicians about their familiarity with MCS, their perceptions and beliefs, evaluation techniques, interventions, referral practices, and demographics. About 30% of the respondents received some MCS training in medical school. Approximately the same percentage believed that MCS is primarily or totally due to physiological causes. Most respondents (over half) believe that MCS arises from a combination of psychological and physiological factors. Only 13%, however, frequently considered chemical intolerance when diagnosing health problems in new patients. For most of the respondents (87%), chemical sensitivity is rarely or only sometimes considered a cause of illness. This lack of awareness means that a practitioner’s office – like other public places – can become a minefield of cleaning chemicals, perfumes, pesticides, and other MCS triggers for patients who are seeking help. Of the 13% who frequently consider chemical sensitivity as the underlying cause of illness, only 6% have a “defined treatment protocol.” Moving to another home, diet restrictions, work restrictions, and air purifiers are the most common interventions recommended by the responding physicians.

Other barriers to treatment stem from patients themselves. A 2008 Japanese study involving patients with sick house syndrome reported that people were often unaware that chemicals they smelled in their new homes could severely damage their health. Many believed that ventilation would adequately reduce their exposure. Patients did not understand that low-level exposure to toxic chemicals perpetuates MCS. They balked at moving to another residence, both for economic reasons and because they had no guarantee that the next residence would be any better for them. In some cases, MCS leads to such debilitation that patients can no longer work; they literally cannot afford to move.

Gibson and Lindberg say, “… given that a high percentage of people with MCS attribute the onset of their illness to chemical exposure, there is a need for greater understanding of the toxic effects of chemicals in ambient air” – a greater understanding by both practitioners and the public at large.

Caress SM, Steinemann AC. A review of a two-phase population study of multiple chemical sensitivities. Environ Health Perspect. Sept. 2003;111(12). Available at http://ehp03.niehs.nih.gov/article/info:doi/10.1289/ehp.5940. Accessed July 16, 2012.

Gibson PR, Lindberg A. Physicians’ perceptions and practices regarding patient reports of multiple chemical sensitivity. ISRN Nursing. 2011. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3168894. Accessed July 2, 2012.

Imai N, Imai Y, Kido Y. Psychosocial factors that aggravate the symptoms of sick house syndrome in Japan. Nurs Health Sci. 2008;10:101–109.

BioGeometry

and

EMFs

After Swiss-com installed a mobile phone antenna on a church in Hemberg, Switzerland, in 2002, about a dozen residents reported sleeping disorders, headaches, and impaired concentration to the Mediation Authority for Mobile Communication and Environment (OMK). The antenna was well within legal parameters, a fact that did nothing to mollify the affected residents. Given the tensions between the residents and Swiss-com, OMK decided to contact Dr. Ibrahim Karim, an Egyptian architect who developed BioGeometry. Karim believed that he could help the residents by using his patented shapes and design principles to induce a harmonizing, beneficial energy quality. BioGeometry evolved from Karim’s study of “the French system of Physical Radiesthesia [dowsing] and its Ancient Egyptian origins” and his study of Earth’s subtle energy grids, sacred power spots, and the historical placement of buildings.

Over a period of six days, Karim installed wood and plexiglass geometric forms on the electrical cables of the antenna, inside the church, and in the homes of the complainants. A symptom questionnaire, given to the affected residents by Dr. med. Yvonne Gilli, reflected a significant decrease in symptoms, a decrease that has continued. Residents also noticed that bats, which disappeared when the antenna was activated, returned to the area.

The success in Hemberg encouraged local government officials in Hirschberg, in the Swiss canton (state) of Appenzell, to ask Karim for help. Ten years before, a multifunction cellular tower was placed near homes and stables, leading to numerous health complaints from local residents. As in Hemberg, Karim’s geometric shapes “harmonized” the antenna’s radiation. Residents reported less fatigue, fewer headaches, improved sleep, and less irritability. Miscarriages among local cattle, dogs, and cats also declined. “The Appenzell project was covered by Swiss National Television step by step,” Karim writes in his book Back to a Future for Mankind: BioGeometry®, “and was aired as a documentary that acknowledged the success of the project, and noted the sustained satisfaction of the residents of the village of Hemberg (the first project), two years after the BioGeometry solution was implemented.”

Not surprisingly, Karim has been called a fraud and charlatan – although not by the people he has helped. The idea that geometric shapes can affect the quality of electromagnetic radiation is far beyond our current understanding. Yet, Karim points out in his book that shapes affect the transmission of sound in buildings (acoustics), and sound is just another form of energy. Every living being on Earth is now exposed to unprecedented amounts of human-produced electromagnetic radiation. Independent researchers have documented harmful biological effects of this nonionizing radiation; but returning to a less technological, less connected, world isn’t plausible. So, the question becomes, how can we make it safe for all of us? Karim’s BioGeometry may be one solution. Certainly, the experiences in these two Swiss towns indicate positive effects.

“The electromagnetic waves used by television, radio, mobile communication and other types of wireless technology are carrier waves, which means that they carry information or media content over long distances with wide coverage,” Karim writes. “Why couldn’t they then also carry health supportive information into the subtle energy systems of life? They could carry the balancing energy quality of BioGeometry. Imagine all the waves in the atmosphere of the Earth carrying this energy. The energy balancing qualities would spread everywhere.” It’s a beautiful vision.

More information about Karim’s work and his book is available at www.biogeometry.com.

Signs of Chemical Sensitivity

“The body often provides early warnings of chemical damage,” according to Grace Ziem, MD, DrPH. These warnings take the form of many common symptoms. Ziem, who has taught occupational medicine at the University of Maryland School of Medicine and occupational health policy at Johns Hopkins School of Public Health, evaluates and treats patients with chemical injury in her medical practice. She has also acted as a consultant for numerous government agencies and the World Health Organization.

On her website, chemicalinjury.net, Ziem emphasizes the importance of recognizing chemical injury early instead of masking symptoms with medications. Drugs cannot heal chemically induced symptoms. They simply disable the warning signal, allowing chemical damage to continue unchecked. Improvement is not possible without identifying and avoiding the chemical triggers.

Warning symptoms vary according to individual susceptibilities and the type of chemical(s) involved. Initially, only one or a few symptoms arise. These early symptoms typically improve or disappear when the person avoids the trigger for a period of time, such as during a weekend outdoors with plenty of fresh air (no pesticides, ozone, etc.). Further exposure usually worsens the initial symptoms and produces additional ones. Chemicals that are inhaled, ingested, or transmitted through the skin can trigger migraines; burning, irritated eyes (itching signifies allergy); rashes and hives; dizziness; cognitive symptoms (confusion, poor concentration, memory loss); numbness/”pins and needles”; imbalance; tremor; weakness; poor coordination; blood pressure changes; increased or irregular heart rate; respiratory symptoms; and gastrointestinal symptoms. Respiratory signs of chemical exposure include irritation, inflammation, burning, and congestion that affects the nose, sinuses, throat, voice box, bronchi, and lungs. Painful ears are another warning sign. If chemically induced inflammation continues unchecked, chronic fatigue and aching arise, usually in addition to earlier warning symptoms.

“‘Acid reflux-like’ symptoms are common in chemical injury,” Ziem states. “This can include irritation/burning feeling in the stomach or esophagus area (mid upper abdomen, lower middle chest), gas/bloating [sic]. If these symptoms are or become frequent or serious, consider a chemical cause.” Since chemically induced GI inflammation is not due to increased acid, Ziem urges patients to have their stomach acid measured before taking acid-blocking drugs that will eventually impair digestion.

Ziem urges practitioners, “Trust your patient’s history. … You may not understand the effects: that does not mean they do not exist or are ‘imagined’ or psychological in origin.” Be particularly alert to the possibility of chemical sensitivity if the patient reports an increase in symptoms within 48 hours of a chemical exposure, if the symptoms disappear or worsen in a different setting, or if symptoms have worsened with repeated exposure. A patient log with the date, time, symptoms, and exposures or situations can be very helpful in tracking down triggers. Failure to recognize the presence of chemical sensitivity can lead to worsening symptoms and disability. For more information, see Ziem’s website, http://www.chemicalinjury.net.

About Dr. Grace Ziem [Web page]. Chemical Injury.net. http://chemicalinjury.net/biosketch.htm. Accessed July 2, 2012.

Ziem G. Recognize early warnings! [online document]. Available at http://www.chemicalinjury.net/preventingchemicalinjury.htm. Accessed July 2, 2012.

Electromagnetic Hypersensitivity Review of Evidence

The 2011 review “Electromagnetic hypersensitivity: Fact or fiction?” outlines a history of current knowledge about human-produced electromagnetic radiation (EMR) and its health effects. The Canadian authors, Stephen J. Genuis and Christopher T. Lipp, also present ideas for helping people with electromagnetic hypersensitivity (EHS). Adverse health effects ascribed to EMR first appeared in medical literature during the 1950s, according to Genuis and Lipp. At that time, Eastern European doctors reported treating “thousands of workers” who either made, repaired, or operated microwave/radio frequency-emitting equipment. This “radio wave sickness” consisted of a range of symptoms including headaches, weakness, sleep disturbance, emotional instability, dizziness, memory impairment, fatigue, and heart palpitations.

Since that time, industry-backed research has disputed the idea that human-produced nonionizing radiation can cause such symptoms. Independent research, however, gives another picture. Most recently, N. D. Volkow and colleagues reported in 2011 that cell phone radiofrequency exposure alters brain glucose metabolism. Also in 2011, a double-blind study, led by D. E. McCarty, documented somatic reactions to EMR in a female physician with self-diagnosed electromagnetic hypersensitivity. The scientists and doctors involved in this study say, “‘EMF hypersensitivity can occur as a bona fide environmentally-inducible neurological syndrome.’”

Genuis and Lipp provide recommendations for treating EHS that are similar to treatment protocols for chemical hypersensitivity: avoiding triggers, correcting nutritional and biochemical deficiencies, and reducing the toxicant burden. The article includes specific measures for reducing exposure to electromagnetic radiation from cell phones, cordless phones, computers, handheld electronics (electric toothbrush, hair dryer, smartphone, electronic tables, etc.), fluorescent lights, household power, high-voltage power lines, and transmission towers and emitters. However, avoiding EMR triggers is easier said than done, given the “ubiquitous” presence of electromagnetic technology. People with electromagnetic hypersensitivity are often forced to become loners, restricting their movements to a few safe sites, because the presence of EMR in public places and homes of family and friends trigger reactions.

People who are hypersensitive to electromagnetic radiation (and chemicals) need to have key nutrients replenished. Nutrients vital for cellular metabolism and the body’s detoxification processes are easily depleted during chronic stress and inflammation. In addition to nutrient supplementation, toxins that add to the body’s stress load must be reduced. “Some recent research is beginning to make the link between specific toxicants such as heavy metals and EHS,” Genuis and Lipp write, “but it is imperative to explore the total load that encompasses the range of potential toxicants including various adverse chemical agents, implants, some dental materials, mold exposures and other toxins.” By addressing all three components of the protocol, Genuis and Lipp say, “… it is possible for patients with [sensitivity-related illness] to improve considerably and be restored to normal functioning.”

Genuis SJ, Lipp CT. Electromagnetic hypersensitivity: Fact or fiction? Sci Total Environ. 2011;doi:10.1016/j.scitotenv.2011.11.008. Available at http://aaemonline.org/images/Genuis_EHS_paper.pdf. Accessed July 30,2012.

McCarty DE, Carrubba S, Chesson AL, Frilot C, Gonzalez-Toledo E, Marino AA. Electromagnetic hypersensitivity: evidence for a novel neurological syndrome. Int J Neurosci. Available at http://www.ncbi.nlm.nih.gov/pubmed/21793784.

Volkow ND, Tomasi D, Wang G-J, et al. Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011;305(8):808–813.

Morgellons Disease Update

Like fibromyalgia and multiple chemical sensitivities, Morgellons disease (MD) has been viewed as a psychogenic condition. Colorful filaments that appear to be growing from skin are deemed textile fibers implanted by the patient. Patients who remove the filaments are diagnosed with trichotillomania (being impelled to pull out their hair). Patients complaining of crawling sensations in the skin are diagnosed with delusional parasitosis. Fortunately, some researchers and practitioners have taken patients’ complaints seriously and investigated.

In 2012, Marianne J. Middelveen and colleagues published evidence that Morgellons disease is not a psychogenic condition. Rather, it is “an emerging dermatological disorder and multisystem illness” with similarities to bovine digital dermatitis (BDD). In BDD, cows develop lesions with long keratin filaments in skin just above the hooves. Spirochete infection appears to be the cause. Some people with MD have tested positive for Borrelia burgdorferi (the spirochete that causes Lyme disease) and other tick-borne parasites.

For their study, Middelveen and colleagues compared biopsy samples taken from cows with BDD with samples taken from three patients. Patient samples consisted of calluses, scabs, filaments, and other dermatological debris. Filaments varied in size and color. Those attached to the epidermis encompassed “single or clusters of hyaline [clear], tentaclelike projections with tapered ends (tentacle diameter approximately 5 um) to macroscopic masses or mats of tangled fibers (approximately 1 mm diameter).” Long, colored filaments (red, blue, purple, black, green) and filament clumps were embedded in scabs. Many of these had bulblike ends similar to hair follicles. All samples underwent microscopic examination, were exposed to three caustic agents to determine reactivity, and were stained for keratin using monoclonal antibodies.

Each of the three participants had suffered with painful skin lesions with fibers for 10 years or more. The lesions persisted despite treatment with antibiotics, steroids, and antiparasitic medication. In addition to the lesions, the patients also experienced fatigue, musculoskeletal pain, and a history of tick exposure. Two of the patients tested positive for the spirochete B. burgdorferi and other tick-borne parasites. The third developed a “bull’s-eye” rash and other symptoms after hiking and removing ticks from his dog.

Middelveen and colleagues observed that MD filaments and BDD filaments originate in pavement epithelial tissue. In addition, MD filaments arise from the inner root sheaths of hair follicles. Keratinocytes (cells that produce keratin) are prevalent in both locations. Microscopic examination, chemical testing, and keratin immunostaining indicate that both the hyaline and colored MD filaments are “consistent with keratin.” “Red, blue, purple and black are colors found in keratin and are associated with structural coloring and/or melanin production,” Middelveen and colleagues explain. Immunohistological and electron microscopy studies are needed to verify that the MD filaments consist of keratin.

Middelveen MJ, Rasmussen EH, Kahn DG, Stricker RB. Morgellons disease: a chemical and light microscopic study. J Clin Exp. Dermotol Res. 2012;3(1). Available at www.omicsonline.org/2155-9554/2155-9554-3-140.pdf. Accessed June 29, 2012.

Neural Therapy

and

Prolotherapy for Chronic Pain

Prolotherapy, which addresses connective tissue weakness or instability, is an alternative treatment for chronic pain conditions, including fibromyalgia. Gerald R. Harris, DO, explains in a 2010 article why he usually begins with neural therapy before using prolotherapy when treating chronic pain. Although both are injection therapies, neural therapy focuses on autonomic (involuntary) nervous system (ANS) damage, caused by trauma, infection, or surgery. The ANS governs the heart and blood flow, digestion, respiration, and detoxification – all the systems needed for healing. By first relieving interference to ANS function with neural therapy, Harris “increases healing capacity.” As a result, prolotherapy is more effective in repairing connective tissue.

During neural therapy, local anesthetics, such as procaine or lidocaine, are injected into scars, peripheral nerves, autonomic ganglia (deep grouping of nerves), glands, acupuncture points, trigger points and damaged tissue. “Doing the injection in the correct site is important because this neural-therapeutic normalizing effect upon the autonomic nervous system can only be produced if the injection reaches previously damaged tissue that can no longer recover by its own efforts,” says Harris. The injection blocks pain input and increases cell membrane potential, improving metabolism and giving damaged cells the opportunity to eliminate metabolic wastes and “shift back towards normality.”

Neural therapy is a popular natural therapy in Germany, where it was first used clinically by physician brothers -erdinand and Walter Huneke during the 1920s. It is useful for acute and chronic pain, headaches, inflammatory responses, poor circulation, rheumatism, sciatica, arthritic joint conditions, frozen shoulder, sports injuries, and allergies. It does not help genetic illnesses or conditions resulting from severe nutritional deficiencies. Neural therapy should not be performed near the uterus during pregnancy as it can trigger miscarriage. Also, neural therapy can affect blood sugar levels so it should not be used on people with unstable diabetes. Neural therapy is contraindicated in areas with active cancer or active infection and in people with severe psychological disorders. A release of unpleasant emotions, associated with the initial trauma, typically follows neural therapy injections; the emotional release can be difficult for people with psychological disorders.

Classes in neural therapy and prolotherapy are available to physicians through American College of Osteopathic Sclerotherapeutic Pain Management (www.acospm.com). Dietrich Klinghardt, MD, PhD, of the American Academy of Neural Therapy (www.kinghardtacademy.com) and Dr. Robert Kidd (www.neuraltherapybook.com) also hold workshops.

Harris GR. Effective treatment of chronic pain by the integration of neural therapy and prolotherapy. J Prolother. May 2010;2(2):377–386. Available at http://www.journalofprolotherapy.com/pdfs/issue_06/issue_06_07_neural_therapy.pdf. Accessed 25 July 2012.

Nutrition for Soft Tissue Healing

Prolotherapy, an injection therapy that uses local anesthetics to relieve pain and generate collagen, is useful for chronic musculoskeletal conditions such as fibromyalgia. Connective tissue cannot, however, heal without an adequate supply of certain nutrients, as Margaret E. Taylor points out in her 2011 article for the Journal of Prolotherapy. Inadequate diets, malabsorption, and undetected celiac disease lead to deficiencies in protein, zinc, copper, manganese, and vitamin C – all of which are required to make and maintain collagen.

“Protein deficiency is known to delay wound healing and many studies show that a protein supplement hastens healing and reduces hospital time after surgery,” Taylor writes. The recommended daily allowance (RDA) for adults is 0.8 grams/kg of body weight per day. Older people need to consume more – at least 1.0 gram/kg/day, according to research. To meet the RDA, an adult who weighs 70 kg (154 pounds) would have to eat one egg (7 grams protein), 5 ounces of tuna ( 28 grams protein), and 3 ounces of meat, poultry, or fish (21 grams protein). An older person with the same weight would need an additional 14 grams. Unfortunately, appetite tends to decline as people age. In addition, older people are more likely to prefer sweet and starchy foods and less protein because of a taste disorder related to zinc deficiency. Protein drinks with low sugar might be a helpful source of protein for older people. Unlike high-protein whole foods, however, these drinks do not always contain zinc.

Mild zinc deficiency is common. Taylor’s clinical experience has taught her that zinc deficiency along with irritable bowel and fatigue are signs of gluten sensitivity. She reports that many of her prolotherapy patients with signs of undiagnosed celiac disease also have/had growing pains, Perthes hips, Osgood Schlatters disease, scoliosis, and uneven leg length. Gluten sensitivity leads to intestinal damage and poor absorption of essential nutrients, such as zinc. Supplements alone cannot make up for poor absorption due to celiac, but a gluten-free diet will eventually allow the GI tract to heal, and absorption will improve.

The minerals zinc, copper, and manganese are vital for connective tissue growth and repair. Taylor recommends finding a mineral supplement with 25 mg zinc, 5 mg manganese, 1 g copper for use during prolotherapy. “A good rule of thumb in supplementation of minerals is to use a dose between the RDA and twice the RDA, in conjunction with other nutrients,” says Taylor. Excessive doses of zinc interfere with the absorption and effect of manganese, copper, and iron; impair immune response; and slow wound healing. In addition to these minerals, Taylor recommends vitamin C (1000 mg/day), which “can maximize the likelihood of a good response to Prolotherapy.”

Taylor ME. Nutritional support for soft tissue healing. J Prolother. August 2011:3(3);709–713. Available at http://www.journalofprolotherapy.com/index.php/nutritional-support-for-soft-tissue-healing. Accessed June 28, 2012.

Ziem Treatment Protocol for Neural Sensitization

Grace Ziem, MD, an expert in occupational health and chemical injury, has developed a treatment protocol for neural sensitization. Neural sensitization, according to research by Martin Pall, PhD, is a cyclical biochemical process in which increased nitric oxide production leads to increased peroxynitrite, a potent free radical. Peroxynitrite causes tissue damage, widespread inflammation, and produces more nitric oxide – leading to even more peroxynitrite.

Patients with chemical sensitivity can develop a variety of symptoms due to inflammation that accompanies neural sensitization: sinus, ear and/or throat pain; congestion; coughing, wheezing and/or shortness of breath; migraines, easy bruising; episodic hypertension with increased blood pressure (when exposed to trigger chemicals); angina with increased anginal pain (when exposed to triggers); irritable bowel; nausea; acid-reflux-like symptoms; diarrhea and abdominal discomfort, burning and/or irritation of the urethra, vulva, seminal vesicles and other urinary lining tissue; burning/irritated eyes; skin rash and/or burning sensation. Chemical injury can eventually produce fatigue and widespread musculoskeletal pain, characteristic of fibromyalgia and chronic fatigue syndrome.

Ziem’s multifactorial protocol addresses the nitric oxide-peroxynitrite-nitric oxide cycle, rather than simply masking the symptoms. The first and most important step is to reduce environmental triggers (petrochemicals, pesticides, perfumes, VOCs, etc.) that can be inhaled, ingested, or absorbed through the skin. “It is essential that ENVIRONMENTAL CONTROLS BE MAINTAINED IN THE HOME, SCHOOL AND/OR WORKPLACE,” she says [sic]. Eating food grown without chemical pesticides is an important aspect of reducing triggering chemicals; this is just one dietary recommendation. Ziem also advises patients to eat protein with each meal, avoid refined carbohydrates, and eat more alkaline than acid-forming foods. The body’s enzymes work better in a slightly alkaline environment. Her website includes an “Alkaline Diet for Healing” chart.

In addition to environmental controls and diet, Ziem’s protocol includes supplements that help break the neural sensitization cycle. Glutathione (preferably delivered by nebulizer if the patient can handle it) is a powerful antioxidant and helps regulate the nitric oxide cycle. For patients with reactive airway disease and/or migraines who cannot tolerate the nebulizer, Ziem recommends a transdermal glutathione or specific oral preparation. Another protocol supplement, hydroxocobalamin (a form of vitamin B12), scavenges nitric oxide. Hydroxocobalamin can be delivered via a nebulizer, IM injection, or sublingual tablets. Respiratory symptoms caused by chemicals indicate a particular need for hydroxocobalamin.

Other supplements in the protocol are taken orally. Ziem’s recommendations include ascorbic acid (buffered is best), gamma tocopherol, coenzyme Q10, zinc, copper, manganese (preferable picolinate form), magnesium, selenium to maintain glutathione in its active form, alpha lipoic acid to reactivate glutathione, betaine (trimethylglycine) to donate methyl groups, and bioflavonoids (found in ginkgo biloba, silymarin, bilberry, cranberry, and carotenoids) to reduce the damage of peroxynitrite.

Ziem explains how to use supplements, such as vitamin B12, to reduce symptoms; but, supplements are never meant to take the place of environmental controls that reduce chemical exposure. Symptom improvement and reduced sensitivity to chemicals, light, noise, and other triggers result when patients follow the protocol, says Ziem.

Ziem G. Eating for healing [Web page]. Chemical Injury.net. http://chemicalinjury.net/html/neural_sensitization-pg_11.html. Accessed July 2, 2012.

———. Treating chemical injury: step by step [Web page]. Chemical Injury.net. http://chemicalinjury.net/html/neural_sensitization__treating.html. Accessed July 2, 2012.

———. Using the neural protocol. MCS Canadian Sources. http://www.mcscanadian.org/medical/drs-ziem-and-pall.html [Web page]. Accessed July 2, 2012.