Services Provided at the Nova Scotia 
Environmental Medicine Clinic

By 
Dr. Gerald H. Ross, M.D., C.C.F.P., D.I.B.E.M., F.A.A.E.M., Medical Director

UPdate Fall 1994
 

     In September 1990 the Nova Scotia Environmental Medicine Clinic was established as a pilot project by the Nova Scotia Department of Health, as a cooperative effort with Dr. Gerald H. Ross and the Environmental Health Center – Dallas.  The clinic is operated approximately six times a year for about ten working days at a time and is located on the fifth floor of the Bethune Building at the Victoria General Hospital in Halifax.

     In response to the increasing prevalence and recognition of environmentally-triggered health problems, including allergy and building–related illness, the Nova Scotia Department of Health sponsored Dr. Gerald H. Ross for a two-year training fellowship in Environmental Medicine between 1987 and 1989.  Dr. Ross became a resource physician to the Province, and subsequent negotiations led to the establishment of a pilot project for the delivery of Environmental Medicine services to referred patients at the Nova Scotia Environmental Medicine Clinic.

     The main focus of the clinic was environmental Hypersensitivity, more recently being called Chemical Sensitivity, which is a newly-recognized condition that was first identified about 40 or 50 years ago.  This health problem is characterized by intolerance to concentrations of chemical substances that are found in everyday settings that appear to be well tolerated by most people.

     The symptoms may vary over time and from person-to-person in different situations, but common complaints include fatigue, headache, mental confusion, joint pains, muscle aches, nausea, and depression.  There has been a growing interest in this condition, especially in view of the increasing number of building-related complaints in the Halifax area and in Nova Scotia in general, with the identification of several “sick buildings”.

     In response to this growing awareness, the government of Nova Scotia took the pioneering step of the establishment of the Environmental Medicine Clinic in September 1990.  Essentially, the purpose of the clinic was for evaluation and treatment, limited research, and individual patient education.

     Patients are referred to the clinic by their family physicians or other specialists, who may have a strong suspicion of environmentally-related factors in the production of the patient’s ill health.  As a consequence, there are a variety of health problems which are evaluated at the clinic, including classical allergy (such as asthma, hay fever, hives, etc.), Chronic Fatigue Syndrome (which may have environmental precipitators, or worsening factors) and chemical sensitivity, frequently related to “sick building syndrome”.

 T    here are a variety of services that are available at the Environmental Medicine Clinic including:
   § Comprehensively environmental-Oriented History and Physical Examination;
   § Access to local and out-of-country laboratory analyses of blood, urine, stool, etc.;
   § Intradermal testing to determine the extent and severity of the patient's allergies and sensitivities.  The principal testing methodologies used are serial dilution end point titration and provocation neutralization testing;
   § Sub lingual testing with provocation neutralization techniques, in selected cases;
   § Group and individual patient education to give the patient the information needed to have more control over their disease process;
   § Limited counseling on dietary manipulation, especially the use of rotational dietary pattern, to minimize exposures to foods to which the patient may be knowingly or unknowingly sensitive;
   § Intravenous therapy with a variety of nutrient products, to replenish deficiency states, and to optimize detoxification ability;
   § Referral to a wide spectrum of other health care providers, depending on the patient’s unique presentation and needs.

     An outcome study/patient satisfaction survey was conducted by the Department of Health with the cooperation of the Allergy and Environmental Health Association and the staff at the environmental Medicine clinic.

     The statistical analyses was done by the Department of Health and the results indicated a very high degree of patient satisfaction with the services offered and statistically significant improvements in patients’ symptoms, in many different categories that were evaluated.  The study was only preliminary in nature, but provided some useful and encouraging data.

     An integral part of the clinic operation has been the tremendous support offered by the Allergy Environmental Health Association and by individual patients who have acted as volunteers and educators.  There is no doubt that the camaraderie that has developed at the environmental Medicine Clinic has greatly contributed to the “healing environment” that is present there.  This effort has brought a sense of community and common endeavor to patients in their struggle to find a return to vigorous health and to bring a greater awareness of environmentally-triggered illness to the medical profession and the lay public.

     The dedication and commitment of the clinic staff has been both heart-warming and inspiring, especially considering that many of the volunteers, who have proven so valuable to the clinical operation, are patients themselves with their own limitations because of their health problems.

     At the time of the compilation of this short article, the site selection and approval of a permanent clinic, the Dalhousie University Environmental Health Clinic, has recently taken place.  I am very pleased with this development, as the creation of a university-based clinic for treatment, research and education is a vindication of the message and efforts of committed physicians and patients in Nova Scotia over the past several years concerning chemical sensitivity and other environmentally-triggered illnesses.

     The overwhelming number of referrals to the Environmental Medicine Clinic, especially from an ever-increasing spectrum of medical specialties, is a firm indication that the recognition of environmentally-triggered illnesses, especially chemical sensitivity, is proceeding rapidly within the medical community.