Water Damage Assessments Mold Assessments & Testing Indoor Air Quality Testing

1. Water Damage Assessments Mold Assessments & Testing Indoor Air Quality Testing Chemical & Allergen Sampling Asbestos Testing Fire/Smoke Screening Radon (not real estate) (847) 293-7554 www.eimidwest.com

2. Occupant Air Quality Concerns

3. Overview • Overall investigation process • Sensitivities • Allergies • Immune system dysregulation • Chemical Sensitivities • Sensory Sensitivities • Emotional Sensitivities • Indoor Contaminants • Psychosomatic symptoms

4. Investigation Process Occupant interview Determine if overall problem or sensitive person Locate cause/contaminant Follow-up interview

5. Occupant Interview • Ask everyone, separately, the following questions: • List symptoms • Are symptoms continuous or intermittent • If intermittent, when? • How quickly do symptoms abate? Do they occur at other locations? • “What do you think is occurring?”

6. Occupant Interview

7. Sensitivities Occupant Interview • Allergies & Asthma • Autoimmune • Sensory Sensitivities • Chemical Sensitivities

8. Allergies and Asthma • Most common of all sensitivities • Allergies • 25% of population • Allergen specific • 10-15% mold allergies • Mold specific • Immediate reactions • Delayed reactions

9. Autoimmune and General Inflammation • Autoimmunity: immune system attacks self • General Inflammation: low-level, body-wide immune activity • Examples include: • Lupus • Multiple sclerosis • Crohn’s Disease • Rheumatoid arthritis • Depression

10. Chemical Sensitivities General • Acute sensitivity to a specific, group, or a range of chemical compounds. • Labels: • Chemical Sensitivity • Chemical Intolerance • Multiple Chemical Sensitivity (MCS) • Idiopathic Environmental Intolerance (IEI) • Toxicant-Induced Loss of Tolerance (TILT) • Can be combination genuine or somatic components

11. Reported Symptoms • Symptoms • Headache • Nausea • Gastrointestinal changes • Short term memory problems • Difficulty concentrating • Irritability • Others

12. Statistics • 12-16% sensitive • 80% women • Head trauma, severe infection, initial exposure to pesticides, concentrated VOCs, or moldy buildings • Typically responds to fragrances, gasoline, diesel, smoke

13. Brain-Body connection • Katerndahland Miller 2005 • Women in waiting room of health center approached, 40 with diagnosis of panic attacks chosen • 73% met criteria for chemical intolerance (QEESI) • 78% childhood abuse • 6% of controls met criteria for chemical intolerance

14. QEESI • Dr. Claudia Miller • 1999 QEESI introduced • Self-report survey of symptoms and impact on life • Takes into account masking of symptoms by daily activities

15. Anatomy of Sensitivities • Trigeminal Nerve • Senses chemicals and sensations • Operates muscles in jaw • Over-communication with brain – sensitivities • Can be tested with capsaicin

16. Perception

17. Newer Hypothesis – Sliding Scale Organic and psychogenic components Purely Organic Purely Psychosomatic

18. Sensory Sensitivities • Sensory sensitivities • Touch • Sound • Vibration • Lights • Temperature/humidity

19. Common Indoor Contaminants • Mold • Radon • Dust & mold mites • Pests • Combustion gases • VOCs & chemicals • Pet dander • Indoor particulate matter • Lack of ventilation

20. Common Outdoor Contaminants • Pollen • Pollution • Other organic debris & particulate matter

21. Fungi • Mold • Mildew • Rot • Brown rot • White Rot

22. Fungi CLK estimates ~30 molds common indoors 1.Cladosporium 2. Penicillium 3. Aspergillus 4. Chaetomium 5. Stachybotrys 6. Ulocladium 7. Trichoderma 8. Alternaria 9. Epicoccum 10. Aureobasidium Red = Dominant Outdoors

24. History • 1994: Acute Ideopathic Pulmonary Hemosiderosis in Infants – CDC Report by Ruth Etzel, MD, PhD. • Mold hits media • 1999: Melinda Ballard lawsuit • 2000: CDC report retracted

25. History Cont. • 2001-present: Continued research by CDC, EPA, universities, physicians verifying health effects to damp buildings and microbialy-contaminated buildings

26. Health Effects • Allergies • ~10% of population • Delayed (vs. immediate) allergies prominent • Specific for mold species • Asthma • Rare • Infection • Rare – immunocompromised only • Irritation to mucous membranes

27. Health Effects – Toxic? • ~2% Chronic inflammation • short-term memory impairment • “fogginess” • fatigue • muscle aches • Others • Likely not mycotoxins • Multiple inflammagens the cause

28. Dust and Mold Mites • Dust Mite: Dermatophagoidesfarinae • D. pteronyssinus • Der f 1, Der p 1, and Der P 2 • Mold Mite: Tyrophagusputrescentiae

29. Combustion Products • Combusting gas produces • Irritant gases • Moisture • Carbon dioxide • Carbon monoxide

30. Combustion Products Cont. • Unvented gas ovens • Backdrafting water heaters or boilers • Backdrafting furnaces • Cracked heat exchangers

33. Volatile Chemicals • Many sources of volatile chemicals • Cleaning agents • Pressed and composite wood • Carpeting on damp concrete • Scented air fresheners • Industrial processes • Combustion sources

34. Measuring Volatile Chemicals • Charcoal tubes and air pumps • Suma canisters • Photoionization detector • 0-500 microgram per cubic meter of air (µg/m3) is normal • Equivalent to ~250 parts-per-billion (ppb)

35. Thank you! Cassidy Kuchenbecker (847) 293-7554 CK@eimidwest.com • $475 site assessments • with free sampling for many projects

36. Psychological Influences • Somatization Disorder • Hypochondriasis • Obsessive Compulsive Disorder • Panic/Anxiety Disorder • Major Depressive Disorder • Bipolar Depressive Disorder • Psychotic Disorders

37. Somatization Disorder • Not hypochondriasis • Recurrent or chronic symptoms complaint with no biological trigger • Also called Briuet’s Syndrome • Often changes doctors • ~1% of women exhibit disorder • <1% of men exhibit disorder

38. Somatization Disorder • Clues: • Have long, detailed history supporting their belief • Takes many medications • Difficulties in social relationships • Often self-centered attitude • Often excitable • Often symptoms presented with gusto – • “I wake up stiff as a board”

39. Hypochondriasis • Hypochondriasis is the fear that the person has a serious illness • Difference from somatization is that hypochondriacs are obsessed with health, not focused on specific recurring symptoms.

40. Hypochondriasis • Clues: • Usually describe fear versus symptoms on phone • Long conversation on what the internet says • Often will just say “I’m a hypochondriac” • Relatively easy to help…if you act confidently

41. Panic/Anxiety Disorders

42. Anxiety Disorders • Clues • Hyper vigilant • Easily startled • Over activation of autonomic nervous system • Sweating • Dizziness • Cold and clammy hands • Pounding heart • Frequent urination

43. Psychotic Disorders • Psychotic disorder • Alters perception, thoughts, or consciousness • Alterations are called delusions or hallucinations • Typical example – Schizophrenia • Delusional Disorder

44. Psychotic Disorders • Delusional disorder • Often paranoid • Delusions more mild than schizophrenia • Feeling followed • Belief in being poisoned