The White Alice sites were established in the late 1950s in Alaska by the Air Force for communication with early warning systems during the Cold war. They were operational until the late 1970’s, about the time my parents moved to Alaska. However, many were not demolished, dismantled or cleaned up in any way until the 1990s or later, potentially affecting the health of the local populations. This is about the White Alice site in Aniak Alaska, where I’m from.

The Division of Spill Prevention and Response lists the site as Aniak White Alice Communications Site or Aniak WACS. The address listed may be surprising as it is the Aniak Middle School. As the WACS, it was operational from 1955 until 1979. The contaminants still of concern are polychlorinated biphenyls (PCBs) and petroleum products. The Alaska Department of Environmental Conservation (ADEC) and the Air Force did a cleanup of the PCBs from 1979-1981. The land became property of the State of Alaska at this time. The site would then be used by the Kuspuk School district to house teachers and students, to conduct official business and have parties. I remember an annual thanksgiving event for the school district staff and their families that was always held there. It was the vocational education (Voc-Ed) center for the high school and then became the middle school. My entire generation went to school there. Many of us lived near there and played there. The housing project and Teachers’ Road were within a mile of the property. In 1994, ADEC became aware of the possibility of persistent contamination. In 1996 and 1997, high levels of PCBs were documented to persist in the soil surrounding the middle school. The Corps of Engineers cleaned the inside of the building and covered the contaminated soil in 1998. There are expected to be persistent contaminants to this day.

The health effects of PCBs seem to have a latency period. They persist in soils and on surfaces and can travel far distances depending on molecular mass so exposure can take place over long periods of time. They can be carried in bodies of water and on the breeze. They also bioaccumulate and persist for many months to years in tissues (fat) where they are bioactive and liver toxic. PCBs can disrupt genes; the endocrine, immune and nervous systems. They have been labeled probable carcinogens by the Environmental Protection Agency as have they been implicated in hormonal, neurologic, skin and gastrointestinal cancers in humans. They may also cause developmental or neurocognitive effects in the offspring of those exposed. Exposure is often through direct contact, inhalation, or consumption of water or meat in which it was bioaccumulated (fish). PCBs can be found in breast milk.

PCBs may affect steroidogenesis by the adrenocortex and lead to endocrine tumors, diabetes, or thyroid dysfunction. This is of interest to me as my older brother has a rare cancer-adrenocortical carcinoma. He also developed type 2 diabetes at a fairly young age. He lived at the Aniak Voc-Ed center as a fetus/infant, was born in 1980 after my parents moved to Aniak in 1979. They drank the water and used the facilities of the building, unaware it was contaminated. The family moved after several months, but our property was not a mile away when I was born. We played around the then Voc-Ed center as children since there were concrete blocks and other industrial leftovers that were fun for climbing and military artifacts to find. There were definitely old rusty oil drums. It didn’t bother us as kids. We picked berries there and played on the nearby playground. We wandered in the woods behind our house and adjacent to the Voc-Ed daily in the summers. In the spring, Aniak would flood most years- carrying debris from place to place to settle for the next year. It is expected that everybody in Aniak was exposed to the contamination. My concern is that my brother and others from my community may have been adversely affected by the White Alice contamination, even suffering life threatening and life changing illnesses due to exposure during their formative years. The site is still listed as contaminated by the Division of Spill Prevention and Response. It was a devastating spill, with insufficient cleanup in one of the purest parts of the planet, with possible ramifications for years to come. I am seeking and collecting stories from fellow Aniakers who think they may have been affected by the contamination to further our understanding of potential health outcomes from PCB exposure. Contact Brück Clift, MD at PO Box 2646 Palmer, AK 99645 or call 907-746-6686

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2836902

https://www.newsminer.com/extra/alaska_pulse/to-circumcise-or-not-to-circumcise/article_3f6edcf8-e116-11ec-95fa-dbfc8eb6a853.html

It’s almost cliche. An elderly woman’s ‘hip fracture’ precipitates the beginning of the end of her life. Being incapacitated, and often requiring surgery, she is at increased risk because she already has advanced age-related cardiovascular disease and atherosclerosis. There may be discussions about quality of life if various procedures are performed versus avoided. If surgery is not performed, she may not walk. She may have pain. Being sedentary, with a fracture, thromboembolic events are considerably more likely. Surgery to repair the fracture is performed, and under general anesthesia, the patient suffers ischemic events to the brain. Cerebrovascular transient ischemic attacks may not be seen on imaging of the head. However, large cerebrovascular accidents would. The woman is confused post-operatively and never fully cognitively recovers. Her vascular dementia progresses until her demise within weeks to years. 

Could this all too common vignette have been avoided? One simple fall could have a huge impact on the future of an individual. Osteoporosis is a progressive disease in which bone density is reduced, leading to increased bony fragility. Osteoporosis increases risk of low-trauma fracture (fracture sustained from standing height or less). Because postmenopause, older age, and female gender are all factors associated with a greater risk for osteoporosis or osteopenia it is recommended to screen all women 65 years or older. X-ray or CT specialized for bone density evaluation is used. Women younger than 65 may be screened if they have risk factors such as previous fractures, low body weight, cigarette smoking, excessive alcohol use, hypogonadism, premature menopause, gastrointestinal absorption disorders, or liver disease. For men screening may be prompted by history of loss of body height, history of endocrine or metabolic disorders, and long term steroid use. 

Because most individuals reach their peak bone mass in their 20’s, it is important that children have healthy bone-forming years. This means that they should take in enough vitamin D and calcium. They should maintain body weight in the healthy range for their age and height. They should exercise as much as possible. It is a healthy choice to avoid smoking and alcohol consumption in the adolescent years for many reasons, but healthy bone growth is an important one. Use of glucocorticoids or anticonvulsants could also adversely affect bone growth. Chronic inflammatory disease and diseases affecting gastrointestinal absorption of nutrients can adversely affect bone formation during youth. Healthy children 9-18 years old, without known deficiency, are recommended 1300mg total daily calcium and at least 600 U vitamin D.  Vitamin D3 is also better absorbed than D2.   Calcium should be mostly dietary, however, and more than 500mg of elemental calcium supplementation per dose is likely not to be utilizable in the body. 

Unfortunately, age related bone loss in both men and women may begin shortly after peak bone mass occurs. For women, the rate of bone loss seems to be highest during perimenopause. Decreased estrogen production is strongly associated with decreasing bone mineral density. The severity of bone loss may be mitigated by similar lifestyle factors as were needed to achieve peak bone mass in adolescence – high impact exercise most days of the week along with a healthful and varied diet. Supplementation with calcium and vitamin D may be more necessary at this age. Fall prevention becomes very important if osteopenia and osteoporosis do develop (an inevitability for many of us). It is recommended that adults quit smoking and take in only moderate alcohol, if any.

Most people are aware that dairy products are good sources of calcium. To estimate the amount of elemental calcium per serving, multiply by 300mg. Calcium citrate is better absorbed than calcium carbonate on an empty stomach. Excess calcium intake may be associated with kidney stones. Calcium may be found in dark green vegetables, some nuts. It may be in breads, cereals, soy products and fruit juices as fortification. For supplementation, up to 1500mg elemental calcium can be taken daily in divided doses of 500mg or less. A daily dose of at least 1000mg should be taken for healthy adults and 1200mg for postmenopausal women. Vitamin D is produced in the skin during exposure to sunlight. It is generally not found in the diet, but is found in fortified milk and infant formula. It is not excreted in breast milk so 400U of vitamin D daily is recommended for breastfed infants. The number of cups of milk x 100U may approximate the daily dietary D intake. 

Lack of sun exposure is a frequent cause of D deficiency. Vitamin D deficiency has been associated with poorer prognosis in infectious and chronic disease states, and can increase risk of fractures. Muscle weakness, depression and fatigue may be signs of D deficiency. Low D increases parathyroid hormone production and leads to bone resorption. For healthy Alaskan adults, up to 5000U daily vitamin D3 supplementation may be considered. More may be required for those already deficient. 

In addition to calcium and vitamin D supplementation various medications are available for those at risk, or already suffering from, osteoporosis.  These all have potential adverse side effects so are available by prescription, after a discussion with a healthcare provider.  Hormone replacement therapy, bisphosphonates, or raloxifene may be recommended; if not otherwise contraindicated. 

SUNDAY, APRIL 24, 2022 AT 6 PM – 9:45 PM

Brück Clift MD Fifth Anniversary Ball and 40th birthday party

Palmer Train Depot/ Community Center

Formal attire encouraged, but not required!

Brit Milah is a ritual performed by Jews on the eight day of life. It combines a religious naming ceremony with the neonatoal circumcision, initiating a boy into Jewish life. I completed the course work this summer to perform the blessings and ritual, having already been proficient at the circumcision procedure. This was an important milestone for me as finding a mohel/mohelet (one who performs the Brit Milah) in Alaska or any rural area has always been a challenge. This achievement also pulls together my love of party planning, Judaism and the medical procedure itself.

Vaccinations are now available (by appointment) to those people 50 years or older with high risk health conditions and who are frontline essential workers. Also included are people of any age who work in childcare or school settings or who live in group homes or congregate living. Those working in healthcare and those 65 years and older are still encouraged to schedule for vaccine if they haven’t already had their first dose.

http://dhss.alaska.gov/dph/Epi/id/Pages/COVID-19/VaccineAvailability.aspx

We have appointments available starting Februrary 9, 2021 to established patients 65 years and older or to patients who work in healthcare. Please call to schedule only if you fit into these categories because we must adhere to strict phases and tiers, but also have limited time to dispense the vaccines as they expire after 4 days. We will be getting them in on Mondays and dispensing them throughout the week during February. This is through the state’s public Vaccine Depot. Please schedule, rather than drop in, due to social distancing requirements and the limited availability and stability of the vaccine. You must receive the second dose from the same source as administered the first, so we will be scheduling the second dose at the same time as the first is administered. Patients who have had a first dose at another office may not receive their second through our clinic.

http://www.newsminer.com/extra/alaska_pulse/what-is-love-its-lots-of-things/article_2b61476c-634c-11eb-93f5-475eb76073f0.html

http://www.newsminer.com/extra/alaska_pulse/many-factors-can-lead-to-depression/article_1191fd56-4bb7-11eb-9d7f-039bb0f63443.html