Symptoms sound familiar/Mystery Ilness? yeah right!

[Guest guest]

Read between the lines on this one and I will not comment any

further due to personal reasons....

KC

June 7, 2005

After a Shower of Anthrax, an Illness and a Mystery

By SCOTT SHANE

New York Times

nytimes.com

ANNAPOLIS, Md. - During the anthrax mail attacks in 2001, Bill

Paliscak, a gung-ho, hockey-playing postal investigator who had

missed 3 days of work in 11 years, removed a filthy filter above a

mail-sorting machine to preserve it as evidence. Anthrax-laden dust

showered down on him.

Four days later he began to feel feverish. Soon he was in intensive

care. After spending the next three years in and out of the

hospital, Mr. Paliscak, 41, now needs a wheelchair to move about,

sleeps with a breathing device to get enough oxygen and takes dozens

of pills a day.

His medical bills total more than $800,000, and he has been living

in a motel here for more than a year because he cannot reach the

shower on the second floor of his home.

Yet Mr. Paliscak (pronounced PAL-uh-sack) remains a medical puzzle.

Blood tests never detected the bacteria that cause anthrax or the

antibodies the immune system should produce in response. As a

result, the federal Centers for Disease Control and Prevention never

classified his disease with the 11 confirmed cases of inhalational

anthrax, 5 of them fatal.

Mr. Paliscak's nondiagnosis ultimately has had little practical

effect, because the Department of Labor agreed in 2002 that his

illness was work-related, permitting workers' compensation to cover

his medical bills and provide support of about $1,000 a week. But

the C.D.C. decision rankles Mr. Paliscak, his family and his doctors.

" It sort of feels like - 'You don't believe me,' " says Mr.

Paliscak, rocking in agitation in his wheelchair, his old Postal

Inspection Service bag sitting on the floor nearby. " I've dedicated

my life to law enforcement and the military. And an agency of the

government I was sworn to protect won't accept this. That bothers

me. "

After consulting with dozens of specialists across the country, his

doctors at Sinai Hospital of Baltimore remain convinced that his

anthrax exposure produced his disease, in part because exhaustive

testing found no other cause. They believe his experience may hold

scientific lessons about anthrax, which experts consider the

likeliest weapon in future bioterrorist attacks.

" I think we can still learn something from Bill's case, " said Dr.

J. Kerkvliet, an internist at Sinai who has cared for Mr.

Paliscak since 2001. Dr. Kerkvliet says he fears the C.D.C. " has its

head in the sand. " A colleague, Dr. Tyler C. Cymet, who spent months

talking to the confirmed anthrax survivors and their doctors,

said, " I come down strongly on the side that this is anthrax. " Few

diseases cause " whole-body symptoms " as does the toxin produced by

anthrax, said Dr. Cymet, who, like Dr. Kerkvliet, is an assistant

professor at the s Hopkins medical school.

The variety of symptoms Mr. Paliscak suffers would be enough for a

hospital ward full of patients. His limbs swell with fluid, pushing

his previous weight of 185 pounds as high as 310. His hormone-

producing glands have shut down, setting off a cascade of secondary

effects.

He experiences spells of overwhelming fatigue that can last for

several days. His legs regularly are gripped by painful convulsions,

the thigh muscles shaking as he struggles to hold them still.

But C.D.C. officials, who declined to discuss Mr. Paliscak's case,

say they cannot bend diagnostic criteria. " Case confirmation is

based on laboratory results and is an essential starting point in

any public health investigation and for medical treatment, " the

agency said in a statement.People who knew the muscular ex-marine

say they hardly recognize him now. " He was in tip-top shape, " said

T. Carroll of Quakertown, Pa., a former hockey teammate who

was best man at Bill and Paliscak's 1996 wedding. " He was

the kind of guy who could skate the whole game. "

Now, Mr. Carroll said, his friend is " a totally different person. "

At Mr. Paliscak's mother's funeral in 2003, " when they wheeled him

in, my wife just lost it. "

" I probably wouldn't have known him, " Mr. Carroll continued.

One key to the mystery may be the paucity of data on the

inhalational form of anthrax. " Historically, there haven't been a

lot of survivors to study, " said Dr. Philip S. Brachman, who studied

five cases at a New Hampshire mill in 1957 - the largest cluster in

the United States before 2001.

Before the anthrax letters, of the 18 cases of inhalational anthrax

diagnosed in Americans during the previous century, 16 were fatal,

he said.

Anthrax remains largely an animal disease, with cattle or other

mammals periodically infected by inhaling spores that can lie

dormant for a century in soil. This very hardiness attracted

biowarriors of a half dozen countries in the 20th century, who made

anthrax the core of their arsenals.

Whoever mailed anthrax-laced letters in Princeton, N.J., on Sept. 18

and Oct. 9, 2001 - the case is still unsolved - proved its

effectiveness as a killer and contaminant.

Two postal workers at the Brentwood mail processing center in

Washington, where Mr. Paliscak removed the filter, died of

inhalational anthrax and two others survived it. The cost of

cleaning up the billions of spores that leaked into the building

from two letters addressed to Democratic senators exceeded $100

million.

Even after gas had exterminated all the anthrax spores, workers re-

entered the cavernous structure in moon suits, just in case.

But in the first days after the letter to Senator Tom Daschle was

discovered in October 2001, the drive to act outpaced officials'

understanding of the exotic bug. As Mr. Paliscak gathered evidence

around Delivery Bar Code Sorter No. 17, an anthrax hot spot, he wore

only a hardware-store dust mask for protection.

Testing would show that the filter he removed was thick with anthrax

spores. He got sick four days after exposure, the mean incubation

time of the confirmed cases. Some of his symptoms, though not all,

would resemble theirs. Like him, they have recovered slowly and

incompletely, complaining of a bewildering variety of ailments.

" I feel a little better, " said R. Hose, 62, of Winchester,

Va., who was infected at a State Department mailroom. " I think my

stamina is a little better. But I'm still on seven kinds of

medication. "

Mr. Hose and the other official victims tested positive for anthrax.

Mr. Paliscak did not. Studies have shown that a dose of antibiotics

can kill the bacteria while still allowing the toxin to do its

damage, and Mr. Paliscak took two antibiotic pills in the first

couple of days after exposure. Yet other tests - one to look for

anthrax DNA, another to find antibodies - also found nothing.

As Mr. Paliscak became deathly ill, cycling in and out of Sinai

Hospital, his wife and friends from the Postal Inspection Service

pursued a workers' compensation claim. After initially rebuffing the

case, the Department of Labor ruled in May 2002 that while it could

not justify a formal diagnosis of anthrax without a positive test,

some major symptoms - inflammation of the heart and lungs - were

caused by dust exposure at Brentwood.

The department eventually assigned a top manager to track the case.

But medical bills went unpaid for months on end, creating havoc with

the Paliscaks' credit and causing several medical facilities to

temporarily suspend services.

Though a hospital administrator herself, Paliscak found the

effort to get treatment and payment for it daunting. " It's a maze

that no one has any directions to get through, " she said.

After Mr. Paliscak finally went home in late 2003, he spent more

than six months taking sponge baths, because the only shower is on

the second floor. The Department of Labor agreed to put in an

elevator and chose contractors for the work. But after a shaft was

opened and the house became virtually uninhabitable, the elevator

contractor disappeared.

They were to spend two weeks in the Marriott Residence Inn during a

$10,000 house renovation. They have been in the motel for a year, at

a cost to workers' compensation of $30,000. One night Mr. Paliscak's

pizza dinner was interrupted when a car crashed through the motel

wall and into his room. He switched rooms.

Shelby Hallmark, director of the office of workers' compensation

programs at the Department of Labor, acknowledged that computer

problems fouled up bill payments and blamed an unscrupulous

contractor for the elevator delay.

But he said the program had spent nearly $1 million in medical bills

and direct payments on the case, even assigning a nurse to help

coordinate Mr. Paliscak's therapy, transportation to appointments

and home renovations.

Anthrax experts asked about Mr. Paliscak's illness had varying

views. Dr. Brachman, of Emory University, said he would not rule out

anthrax as a cause, despite the test findings. Dr. Ken Alibek, a

former Soviet bioweapons expert now at Mason University, was

more skeptical. " You cannot make the diagnosis without laboratory

confirmation, " Dr. Alibek said.

Both wondered whether Mr. Paliscak's illness might be a devastating

reaction to some other substance on the filter, such as yeast or

mold spores. But Mr. Paliscak's doctors said they could find no

evidence for that possibility.

Dr. Leonard A. Cole, a Rutgers University professor who reviewed Mr.

Paliscak's case for his 2003 book, " The Anthrax Letters: A Medical

Detective Story, " said the C.D.C. should have at least labeled Mr.

Paliscak a " suspect " case of anthrax.

" It's more than just an academic question, " he said. " The bigger our

base of knowledge about this disease, the better off we'll be. "

Dr. E. of the National Institute of Allergy and

Infectious Diseases is conducting a follow-up study on the anthrax

victims and has included Mr. Paliscak in her research. But through a

spokeswoman, she declined to comment on his case, saying she does

not want to discuss her study until it is published.

Mr. Paliscak is tired of the debate about his illness and simply

wants to get back to work. " I was one of those lucky people who

really love what they do, " he said.

Some of his colleagues in the Postal Inspection Service are still

investigating the anthrax case, as the fourth anniversary of the

attacks draws nearer. He would like nothing more, he said, than to

rejoin the hunt for the person responsible for killing five people

and sickening 17 others - or 18, if Mr. Paliscak and his doctors are

right.

A year ago, Mr. Paliscak was honored by a law enforcement group and

had a chance to talk with the speaker, S. Mueller III, the

director of the Federal Bureau of Investigation, whose agency has

overseen the anthrax investigation.

" I told him I'd like to be well enough when we catch this guy to put

the handcuffs on him, " Mr. Paliscak said.