More About Lead Poisoning: The Basics

Health Effects of Childhood Lead Poisoning

And now we are hearing about imported toys through the media. Is this a scare? Is it true? How do we know?  We must assume that it is true. The really alarming information is that this may have gone on for years. How do you find safe, quality toys, that are develpmentally stimulating for your children, and not just hazourdous piles of junk?

Environmental Health Hazards

Since 1950, more than 65,000 NEW chemical compounds have been introduced into common use in the western world. 84% have NOT been tested for toxicity.

Superfund sites are hazardous waste sites designated by the EPA to be a threat to human health; these may include leaking underground storage tanks or hazardous waste sites such as municipal dumps and contaminated factories or mines and mills (Chiras, 1994, p. 462nds, )More than 40 million people live within 4 miles of a Superfund site. Approximately 4 million people live within 1 mile of a Superfund site.  Lead very likely will be found in superfund sites.

Environmental Hazards of concern fall into four widely accepted classes

CHEMICAL

PHYSICAL

BIOLOGICAL

PSYCHOSOCIAL

Environmental Health Hazards

In the Home

MOLD

DUST

LEAD

Environmental Health Hazards

What is Lead?

One of the 102 elements (Are there more now? Ii have lost track) from the periodic table

A metal that is naturally found in mineral deposits.

A very stable metal that does not decay for millions of years.

Has been used in numerous products because of its malleability, low melting point, and ability to form compounds (paint, glazes, solder, to name a few)

Historical Uses of Lead

Romans: Used lead as a sweetener; Egyptians: Used lead as a cosmetic; Industry: paint, gasoline, glazes, colored newsprint

Sources of Lead Exposure in the Environment

Lead based paint and soil,oil and dust near lead industries, roadways, railroad tracks, coating the hulls of ships. Homes built before 1978. Imported cosmetics: Indian Surma, Arabic Kohl, Burmese Thanaka. Home Remedies: Azarcon, Greta. Vinyl miniblinds. Imported candies (Mexican tamarind in pots)Imported pottery.   There is lead in some cosmetics, including some “designer” lipsticks.

Other “products” containing lead:

Window blinds. Painted furniture, Leaded crystal glassware and dishes,  Bullets, Keys. Exposure to the remants of war, in water wells, and in the soil, in other countries, though we don’t know about what is here, other than the superfunds.

Sources of Lead Exposure

Hobbies and related activities- Glazed pottery making, glass blowing.

Target shooting at firing ranges, Lead soldering (e.g. electronics)Painting, Preparing lead shot, fishing sinkers, Stained glass making, Home remodeling, Car and boat repair. Cometics, some lipsticks

Sources of Lead Exposure

Occupational

Plumbers, Lead miners, Auto mechanics

Repair of radiators, in particular

Bridge, tunnel, and elevated highway construction

Today…

…Lead-based paint is the single most common source of lead poisoning during childhood.

Routes of Absorption

Ingestion

the most common route for children

Inhalation

not a common route for children

Transplacentally (In Utero) to the developing fetus

Why is lead a problem?

Lead is a neurotoxin that causes serious health problems especially for young children:

Brain damage, growth delays, learning disabilities, other serious health problems

Who is at risk?

Children under the age of 6 years

the brain is still rapidly  developing; high hand-to-mouth activity and they “live” closer to the ground

increased exposure to dust and soil,  increased exposure to carpets: a reservoir for many contaminants

Higher rate of metabolism/absorption than adults

Who is at risk?

Children with certain risk factors

iron deficiency anemia

pica

Children from low-income households (environmental and social justice concerns)because they often live in old run down homes in the poor side of town.

Children with poor nutrition

But in addition, ALL families refurbishing older homes and unaware of the risks to their children

Recent immigrants

How Do We Identify Children with Lead Poisoning?

Lead poisoned child may not look or act sick.Lead poisoning has no symptoms (problems show up later on in school, when it may too late to correct the problem or gain lost educational time). The only way to know is to look for lead poisoning  with a blood lead screening test

Health Effects of Lead Poisoning
(particularly in children)

Learning disabilities, Behavioral problems, slowed physical growth, systemic effects on kidneys and blood forming organs

BLOOD LEAD SCREENING:
WHO & WHEN?

Blood lead screening should be required for:  Any child at risk for lead poisoning.(When:-Ages 12 and 24 months, or as needed-Any time 12-72 months if not tested before-Any time 12-72 months if change in risk for lead poisoning

Blood Lead Screening @ 12 & 24 months: WHY?

Prevents lead poisoning: identifies child with low level; family education prevents blood lead level (BLL) rising to higher/poisoning levels

Why aren’t high-risk children being screened for lead poisoning?

Not ordered by primary care physician, uninsured children not getting comprehensive health care, parents unaware to act as their own advocates, and some providers just don’t believe in neurotoxins in our environment (“we don’t have a problem where we live”).

What is lead poisoning in children? Markowitz definition

“…a disorder characterized by subclinical and biochemical finding in largely asymptomatic children.” (Markowitz. 2000. Lead poisoning. Pediatrics in Review. 21(10): 327-335.

Centers for Disease Control definition

A blood lead level as “low as 10 mcg/dL … associated with harmful effects on children’s learning and behavior.”

How much is a µg/dL (microgram/deciliter) ?

Microgram: A penny weighs about 2 grams. Imagine cutting a penny into 2 million pieces. One microgram would weigh the same as 1 of those 2 million pieces.Deciliter: A deciliter is equal to about ½ cup. Or, you’d get 1µg/dL concentration if you flooded a football field with 2 feet of water and added 1 tablespoon of sugar Message: It takes only a small amount of lead to cause a lot of harm.

There is No Safe Blood Lead Level

IQ score decreases 1/4-1/2 point for every 1 µg/dL rise in Blood Lead Level:

BLL of 4 µg/dL = loss of 1 IQ pointBLL of 12 µg/dL = loss of 3 IQ pointsBLL of 16 µg/dL = loss of 4 IQ pointsBLL of 20 µg/dL = loss of 5 IQ pointsBLL of 28 µg/dL = loss of 7 IQ pointsBLL of 32 µg/dL = loss of 8 IQ pointsBLL of 40 µg/dL = loss of 10 IQ points

Society Impact of an Average Decrease of 4 IQ Points:

50 % less children with IQ > 125Twice the expected number of children with IQ < 80

How Do We Treat Lead Poisoning?

Health Services: Identify elevated blood lead level (EBLL); case management of child/family until resolved (average = 1/1/2 yrs)Environmental Services: Identify lead hazards in the home. Housing Services: Remove lead hazards in the home

Lead Poisoning Case Management

Lead poisoning educationIdentification of lead sourceNutrition educationStrategies to minimize lead exposurePlan of careAssess other health/social concernsReferral for Public Health Investigation or Environmental Investigation through local health departmentTreatment

Remove sources of leadChelation EBLL > 45 µg/dL

Strategies for Reducing Lead Exposure

Frequent hand washingWash toys oftenWet mop floorsWet wipe window sillsWipe your feet outside or take shoes off before entry

Strategies for Reducing Lead Exposure

Frequent vacuuming with a HEPA vacuum cleanerIncreasing dietary intake of iron and calcium (but not in the same meal because iron and calcium compete for absorption by the body.Frequent mealsTake iron with vitamin CRun cold water through the pipes for a few minutes before using water

Lead Poisoning
Case Management

Environmental Services

Environmental Investigation of home by registered environmental health specialistChild focusedTesting procedure

XRF-real time resultscollected samples sent to certified lab for analysis.

Lead Poisoning
Case Management (who would do the case management?)

Housing Services

Review Environmental Investigation results with families/ownersDesign plan for remediation in conjunction with the ownercheck to see if financial assistance is available for remediation by the local public housing departmentReferral to enforcement as needed

There is a national model of combined services under one umbrella (Health, Housing, Environmental though it may not be available where you live)

So back to the “superfund”. we are all at risk. where do we think we are dumping industrial toxic wastes, and what are we dumping: computer equipment, cell phones, batteries. Close to your back yard. We are all at risk.

Factor in here the combination of environmental justice and social justice, not to mention health care justice which we surely do not have in this country right now. What part of our population do you think is most susceptible to lead poisoning? And why?

If you are concerned about childhood lead poisoning, ask you child’s pediatrician, nurse practioner, physician assistant, or nurse. Don’t accept an answer “Oh; don’t worry, Mommy” Tell the provider that you want the simple blood test ordered (a fingerstick)  if you feel that your child is at risk. And don’t stop there. Call your local health department (public health nursing, environmental health, or housing offices).

The last word: yes you can buy lead testing kits at your local hardware store. But they have been proven to be innacurate. The only way to be sure about your child’s blood lead level is to ask your health care provider for a blood lead test for your child.

 I realize that I have referred to pets in my blog before. But I feel that this is important since we live pretty intimately with our pets. Yes; they can be have lead poisoning as well, depending on their environment. If you are concerned about neurological dysfunction in a pet, do ask your veterinarian to test your pet.

 And please do not take “no need” as an answer from your pediatrician or vetrinarian.

Do We Really Need These Drugs?

Until I was hospitalized 1 1/2 years ago for a perforated ulcer,  I was only on one daily Rx medication: the  one pill for keeping my hereditary “borderline” blood pressure under control. However, my “provider” felt she needed to add a calcium supplement to prevent osteoporosis and aspirin to prevent a heart attack and a decongestant, in lieu of just standing upright and blowing my nose. And then, during the hospitalization, Protonix was added (I can live with that). As was Norvasc which resulted in severe hair breakage and loss. I just dumped that one. And a bunch of drugs that caused fluid retention and more drugs to cope with constipation (which I never experienced). Lots of drugs prescribed; few that I took.

Now why did I need all these drugs, and even more that I just didn’t take? Well you know my bandwagon about the pill pushers in this country. And why did I even have a perforated ulcer? Too many inappropriate drugs prescribed for back pain., osteoporosis, nasal congestion!  (I have idiopathic scoliosis and a spinal fracture which didn’t bother me at all for many years when I lifted heavy  bags of books).

So now, without health insurance (yes; one of the 47 million Americans), I am trying more and more to reduce any of this junk, these chemicals, that I put into my body. Why? The side effects. And the cost!  Maybe it is my BP med that is making me a little tired , not the aging process? By the way, the insurance company DID NOT PAY FOR ALL OF MY HOSPITALIZATION AND MEDICAL CONSULTANT EXPENSES.  Surprised? I had to. After a “lay off” due to downsizing at work, with no income, and no insurance. (even though I had worked as a manager for a HEALTH insurance company!). Who pays for all these medications? I go to a local neighborhood clinic that is low cost, for the blood pressure med. But anything else? Well check into Partnership for Prescription Assistance (PPA). They have been most helpful with the drug that will prevent another ulcer.

 As a health professional, I have encountered patients/clients/members who are on as many as 21 medications each day. This is incredible. Who is monitoring this regimen? How can  people keep this straight? How do you do this? And what is really necessary? And what interacts with what other medications?   Contraindications? And what are the side effects? And who is helping to monitor this? No one. Does your doctor/provider/”prescriber” have time to do this? Of course not. And what if all these medications have the resultant side effect of confusion?

 Oh! The answer! Health insurance companies are now providing programs like healthy living support programs that  have nurse case managers who give advice to “members”. The nurse case managers are the gate keepers who help the “members” manage their medications (often from many states away) and keep costs down for the insurance companies (don’t go back to your doctor’s office! that will be a bill that the insurance company will be expected to pay). Just call me, your case manager. the nurse case manager  can talk with you after he/she enters your data into 47 computer  screens.

 So what to do? Think about who you vote for in the next election, and why. No; we don’t need another layer of bureaucracy. We need a WELL THOUGHT OUT PROGRAM FOR NATIONAL HEALTH INSURANCE. So that we can be as progressive as other developed countries. This is just one little step. Think about this.  Don’t just go along with a candidate who says she/he supports health care. You need to look way beyond that kind of statement. What is really in mind? What kind of program? Managed by whom? Who will be in charge? Who will do the oversight? THINK!

The Nursing Profession: Is this one that you would want for your children?

I am sure this article, and I will try to keep it brief and not too inflammatory, could really upset some folks. But I make my statements following 39 years in my profession, with a lot of observation, experience, and education.

There is nursing education, and then there is nursing education. I happened to be an undergrad student in nursing at one of the leading universities  in the country in the 60s. We worked at being professionals, taking courses along with med students. We wanted to be the best of the best. And those that didn’t succumb to organic chemistry and anatomy and physiology persevered. Our class diminished from 300 to 99 over four grueling years! But as the years have gone by, I have observed the disintegration of this professional education.

In the state where I now reside, continuing professional education for nurses is not even required. How embarrassing to the profession. Just send in your 50 bucks each year. It wouldn’t take much science to figure out where I live. Not that it matters. My first position in this state was to spend 2 months teaching maternal and child health, because if I had not been hired that summer, the students would not have been able to graduate in the spring. This was an LPN to RN program. I had 12 students (4 men; 8 women). I tried so hard to motivate them to look toward higher education, to think about what opportunities they might have in their careers. But their sole motivation seemed to just make a few more dollars in the hospital. I found this most disappointing.

And maternal and child health? I was to follow a rigid curriculum and monitor clinical practice. The curriculum was labor and delivery, with clinicals in the hospital. No curricula about maternal health. No curricula about child growth and development.

In my work since then, I have met some young nurses who are truly enthusiastic, motivated, wanting to grow professionally, hopefully into a specialty. I would do anything to help them, even if all it means is a great letter of reference and a lot of support. It is of interest that they came from major universities, but not in this state.

I am still trying to make sense of this state that I have been living in for 3 years. Is it the education in this state? Is it the value system of this state? Or is it a more systemic problem that I have lost track of, despite my staying on top of professional literature. The political climate? At any rate, would you really, in good faith, encourage your child to study for the nursing profession? Is it even a “profession” anymore?

 Well here is my arm chair diatribe, and again, I would like to say, I have no intent of offending anyone, but I am very disappointed in most of my nursing colleagues. Which explains, to a degree, why I left 3 positions this year. I was embarrassed to work for colleagues that I could not respect.

More About Diagnoses And Pharmaceuticals

To those of you who have read my blog, I apologize for repetition. But some issues just don’t go away.

I just heard an ad on tv for health insurance plans to supplement what medicare offers. First of all, just what does medicare offer? And what about the 47 million of us who have no health insurance and are not yet ready for medicare? The ad was about a certain supplemental insurance company, and it was recommended that you discuss this plan with your “doctor” who will help you decide if this plan it right for you. Yah sure! Since when do “doctors” recommend health insurance plans? Well, someone is getting a kick back here from an insurance company. You need to count on your friends and colleagues for this kind of advice: not your “doctor” and not the insurance companies!

All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I had  never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now I look at all health care research with more acute skepticism.

As for HRT (Hormone Replacement Therapy), I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off HRT? No need to. Doing this will not affect your blood pressure and heart rate, and will probably do nothing except have you discontinuing HRT.  I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not? Once again, conflicting conclusions from research.

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives,  their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.

So now we need drugs to fall asleep, drugs to stop restless leg, drugs to make us “regular”? Soon we will need drugs to wake up, get our legs going, and be able to use the bathroom normally?

Have we forgotten to eat a normal, well balanced diet, with fiber,  that would prevent some of these “problems” in the first place? Have we forgotten to just go to sleep to some nice music at 10pm after walking the dog in fresh air? And though I am lax myself about taking vitamins, popping a pill or two each day, if it doesn’t burn up your stomach (drink plenty of water), you won’t have legs that fly around or get stiff and achy, most likely.

Be Your Own Advocate

As you have probably noticed, due to the constraints of health care costs due to the insurance industry wanting to make profits, health care providers have less and less time to spend with you: their patients, clients, members. The average time is 10 minutes or less. Can you have your questions answered? Your needs met? Maybe. Maybe not.  And thanks to the pharmaceutical companies and their agenda, it is easier for a provider to say “take this” and “take that” rather than LISTEN to you and discuss alternatives.

 I had the recent experience of going to a clinic. I left with 2 prescriptions. I ran out the door, prescriptions in hand, to avoid a parking ticket. When I got home, I noticed the prescriptions were for someone else…not for me. This means that someone else very likely received my prescriptions.

 What are the issues here? Safety and Privacy. Just suppose I wasn’t a health care professional myself and didn’t recognize the error. Just suppose I had taken medications not meant for me. Not to mention HIPAA VIOLATIONS.  Please see http://www.hhs.gov/ocr/hipaa/

And this all extends to our pet companions as well. I took my dog to the veterinarian this week. Her allergies were acting up. I was given the usual antibiotic and steroid to get this under control. I knew what the medications were. This was discussed with the veterinarian and stated in my bill. However, I noticed that the bottle of medications DID NOT give the name of the medication or the dosage. Danger! Just suppose my dog had a middle of the night emergency. Just suppose I grabbed her medications and ran out the door. Just suppose the emergency veterinarian asked what meds she was on. Just suppose I couldn’t remember at the time. I called my veterinarian, not to complain, but to express my concern. I believe this is a legal violation. You don’t dispense drugs without labeling the name of the medication and dosage. Sure, you could say, it’s just a dog. Oh well. Suppose my 2 year old grandson had gotten a hold of these?

The bottom line, the important lines:

  • Please be aware of what medications you are getting; check for your name and the name of the medications, and the dosage. While you are doing that, check the expiration date too. Medications, which are chemicals, can change  their composition over time. And some expire; check the date.
  • Please make sure the medical record that is being reviewed, and recorded into, on a paper medical record, or on a computerized record, is indeed yours.
  • Please make sure that your privacy is not being violated. When you are called from the waiting room, your first name is all that needs to be used.
  • Please keep records, at home, of all of your transactions with health care providers and pharmacies.
  • Please extend these reminders to your  family, friends, neighbors, colleagues. and to anyone else that you know is encountering the health care system. Which is everyone.  And don’t forget your pets’ veterinary records. (not long ago I had to have a very old dog euthanized. Never easy. The medical record showed that my younger healthy dog had been euthanized).
  •  BE CAREFUL. YOU ARE YOUR BEST ADVOCATE!  AND YOU MAY BE YOUR ONLY ADVOCATE!

Are Toddlers and Dogs the Same?

Language development: Have you noticed that you talk to your dog the same way you talk to a toddler? The difference is that toddlers keep maturing, and dogs get stuck at around the human age of 3. I find myself, with some embarrassment, saying to my dog “I don’t like that” or “this is inappropriate behavior” or “this is not acceptable”. Yeah; I am sure she understands!? Maybe she does. Dogs are a lot smarter than we give them credit for. Someday soon I am going to count up all the words my dog knows. It is probably around 200. About the same as my 2 year old grandson…Although he knows stuff he cannot express verbally. Just like my dog!

New Position: Week 2

My new position lasted 9 days. I did not sign the contract. Why? Because the salary I was quoted in my interview was 20k more than what the contract stated. Not livable. And again the demeaning and accusatory attitude of persons who don’t have basic management/supervisory skills.  I asked to “think about” the contract for a day or two before signing, and was told “oh, you’ll sign today” but I didn’t.  And the next day I received a call from my manager who said if I did not sign by 3pm, she would have to find someone else. Okay. I was out the door. I felt bad about the sites that I was committed too. But I had to look out for me.

 All this is after I interviewed in August, but all the beaurocratic red tape didn’t allow me to begin work till the end of October! They are lucky that I bothered to show up at all. And I spent more than $200 just getting through the application and certification process, never to be reimbursed.

So this is the third health care position that I have quit this year. Who do I think I am? I am not independently wealthy. But I am no longer willing to work for persons that I do not respect.

 I have a friend who has been a free lance writer for years, who now is recently employed by an insurance company, and struggling with the politics. Here is my ongoing advice to her:

Keep practicing the mantra “let me think about it and get back to you.” Then it sounds like you are cooperative.

As for parties and holidays, “oh thank you for letting me know; I will do my best to be there.” Then do whatever you want to do with NO excuses. If they ask “where were you? why didn’t you come?” “Oh; I am sorry. But I had something come up.” Don’t provide personal/family information.  Be vigilant about who you trust. Maybe you had a deadline.  “I am sorry; I am really busy today.” Doesn’t matter what.  As for costumes and Halloween, come as yourself. So what.