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Dr. Andrew Rynne

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Can exposure to agent orange lead to ischemic colitis?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2873 Questions

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Posted on Wed, 31 Oct 2018 in Digestion and Bowels
Question: I had half my colon removed and it was diagnosed as ischemic colitis. The VA recognizes ischemic heart disease as compensable due to agent orange exposure. I contend that ischemia can attack any internal organ and as I am a Viet-Nam veteran who was exposed to Agent Orange, my disease should also be compensable. Do know of any medical research that could be used to reinforce my claim for disability with the VA?
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Answered by Dr. Bonnie Berger-Durnbaugh 2 hours later
Brief Answer:

What I was able to find:

Detailed Answer:

Hello,

While I believe there are likely to be many illnesses from Agent Orange exposure, and it seems ischemic colon should be included, I can't find documentation to this effect.

The problem is likely that it just has not been studied, so not official reports.

Here is what I was able to find:

1. In 2011, a veteran with ischemic colon attempted to make this case and was denied that it was associated with his military service.

"CONCLUSION OF LAW: A colon disorder to include a history of ischemic bowel disease resulting in necrosis followed by surgical repair was not incurred in or aggravated by the Veteran's active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2011)."

Here is the document it is cited in:
https://www.va.gov/vetapp11/files5/0000.txt
(to see this, copy and paste it into your search bar)

I am not a lawyer, but perhaps a case can be made that this situation has come up before.

2. There are many drugs associated with ischemic colitis, and perhaps an argument can be made regarding the toxicity of dioxin and other chemicals in Agent Orange.

I am trying to think of a specific association with any of the drugs known to be associated with ischemic colitis and the chemical in herbicides (organophosphates).

I'm wondering if a pharmacist might be able to draw a tie there.

"Major classes of pharmacologic agents known to be associated with ischemic colitis include the following: antibiotics, appetite suppressants (phentermine), chemotherapeutic agents (vinca alkaloids and taxanes), constipation inducing medications, decongestants (pseudoephedrine), cardiac glucosides, diuretics, ergot alkaloids, hormonal therapies, statins, illicit drugs, immunosuppressive agents, laxatives, nonsteroidal anti-inflammatory drugs, psychotropic medications, serotonin agonists/antagonists and vasopressors."

This is from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

These are the only things I can find that could be remotely useful. I'm sorry I couldn't find you something more definitive, but after searching, I don't think anything has been documented, or the VA would have included it in their list (or at least I would hope so).

I think the next steps would be to ask a pharmacist and your gastroenterologist.

Regarding asking a pharmacist, you might contact a university that has a school of pharmacy, in writing, and pose it to them.

I looked up University of New Mexico College of Pharmacy - they might have someone who can help:

https://hsc.unm.edu/college-of-pharmacy/

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 1 hour later
Thanks for the rapid response. I'm aware of the case you referenced but it still fails to answer the basic question I have concerning ischemia. The decision was more subjective than based on factual information as the VA is wont to do. My understanding of ischemia, as has been related to me by my doctors, is that the disease can attack any internal organ by shutting off blood supply to the organ causing its demise. I've also had my gall bladder removed and the surgeon said it was a shriveled mass of tissue and that he had no knowledge of why it was in such a deplorable state. If my understanding is correct that ischemia can attack any internal organ then I'm at a loss to understand why ischemic heart disease should be singularly identified as being associated with agent orange and that ischemic colitis is not. Do you have any additional information that could reinforce my position on my appeal to the VA?
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Answered by Dr. Bonnie Berger-Durnbaugh 8 hours later
Brief Answer:

Additional information

Detailed Answer:

Hello,

I'm sorry it has taken me time to get back to you.

As you likely know, ischemia is a description of inadequate blood flow and oxygen to tissues, and so it is an end result rather than a disease in itself.

Yes, ischemia can occur in any part of the body, for different reasons - usually due to blood clots or other things that block off blood vessels - which in themselves are due to different reasons.

So I went looking in the literature to try to find what the mechanism is for ischemic heart disease associated with herbicide exposure because that may be the same mechanism that causes ischemic colitis. And I found this:

It's from page 534 in a textbook called Comprehensive Toxicology, 2nd Edition, 2010, Editor In Chief XXXXXXX McQueen. I can't copy/paste it so I'll write out what I found:

"The mechanism by which [organohalogen/herbicides] mediate cardiovascular toxicity, including hypertension, cardiac hypertrophy, and atherosclerosis, are beginning to be elucidated, and appear to be multifactorial, including oxidative stress, particularly in the vasculature, ..."

So - if these chemicals can cause oxidative stress and resulting damage to the blood vessels of the heart and brain, then it would seem they could do this to blood vessels in other parts of the body too.

And if this happens to the blood vessels of the mesentery/digestive tract, it would explain the gallbladder and colon ischemia.

Hope I have answered your query.

Take care

Regards,
Dr Bonnie Berger-Durnbaugh, General & Family Physician
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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