What can you expect from your GP? The diagnosis of chemical poisoning is suspected from a history of exposures resulting psychometric tests for pilots pdf typical clinical syndromes and confirmed by the appropriate medical tests.
There are a series of criteria to be fulfilled to make a confident clinical diagnosis of poisoning by chemicals. The subject was fit and well prior to chemical exposures. There is evidence of exposure to the putative chemicals and toxins. The subject initially developed local symptoms which became worse with repeated exposures. Similar patterns of disease are seen in other people working under similar conditions. Similar fact evidence from other subjects who have been poisoned such as the Gulf War veterans, sheep dip poisoned farmers, aerotoxic pilots.
There is laboratory evidence of poisoning and effects of that poisoning. There are no other possible explanations for this pattern of symptoms. There is a response to treatment with clinical improvements as a result of detoxification, nutritional and immune support. It is important to realise that the diagnosis of chemical poisoning relies on recognition of a clinical picture. If I saw a photograph of the Queen, standing on the balcony at Buckingham palace, surrounded by members of the Royal Family, with the flag flying above, the band playing below and thousands of people cheering, I would be happy to diagnose that it was indeed the Queen I was looking at.
We have a similar situation with people who have been chemically poisoned. The clinical picture to those trained and used to seeing it is obvious. The problem arises because these people who are poisoned have only presented in the last few years. This is not a long standing recognisable syndrome, it is a new illness. So for a diagnosis of chemical poisoning to be made, not only do the above criteria have to be followed, but a doctor experienced in seeing and treating these new diseases must be able to see the picture.
Just like in the early days of infectious diseases, Koch’s Postulates had to be fulfilled to make a diagnosis of infection, a series of criteria for the diagnosis of chemical exposures is now emerging. This is symptomatic of poor ability to detox. An extreme version of these symptoms results in psychiatric disorders including depression and psychosis. This means that diseases which one might expect in patients in their eighties one sees in patients in their fifties and sixties. Degenerative conditions such as Parkinson’s disease, osteoporosis, heart disease and dementia. Making the diagnosis is all about recognising the clinical picture as above. At the moment there is no single test which will diagnose acute chemical poisoning.