Document EqL8D916NVwo7XGnMreaEGDjb

Trmsv*"* Boston University Medical Center School of Medicine 80 East Concord Street Boston. Massachusetts 02118 Department of Neurology Office of the Chairman (617) 247-5136 D ecem ber 13, 19.82 Stanley Su Ikes 5822 W yatt Avenue C incinnati, Ohio ^5213 Dear Mr. Sulkes: As Chairm an of the D epartm ent of Neurology a t Boston University School of M edicine, I am in te re ste d in studying th e e ffe c ts th a t various substances have on the nervous system . Last m onth, I m et with Dr. R obert Kehoe in order to discuss the research he conducted a t the K ettering Laboratory in the area of the metabolism of lead as well as raise the question of the possible long-term effects from th at exposure. He gave me permission to contact you and the other p a rtic ip a n ts in th a t study w here lead was ingested in th e form of an aqueous solution of lead sa lt or inhaled in th e form of airborne p a rtic u la te s. I am in te re ste d in learning of your c u rre n t h ealth sta tu s and have enclosed a questionnaire for that purpose. Dr. Kehoe was able to give me th e nam es of all th e p a rtic ip a n ts in th a t study bu t was uncertain of six individuals' cu rren t addresses. They are as follows: Floyd Creech, Steven Balog, M artin Riehle, Ivan Ferneau, Harvey Reed, and Donald Hayes. Should you know of th eir w hereabouts, I would be m ost gratefu l if you could send me th at inform ation when you return the enclosed questionnaire. I am m ost g ra te fu l for your co o p eratio n in filling out th e enclosed form and returning it to me a t your earliest convenience. I will keep you inform ed of the jr assistance. D epartm ent of Neurology RGF/cg cc: R obert A. Kehoe, M.D. QUESTI ONNAI RE TO PARTI CI PANTS OF KEHOE STUDY AT KETTERI NG LABORATORY oday' s Dat e: -/ / Backgr ound I nf or mat i on 2. Name: 3. Addr ess: 4. Tel ephone #: 5. Soc. Sec. #: 6. Dat e of Bi r t h: L/ 7. Pl ace of Bi r t h: 8. Sex: __________ 9. Race: _________ 10. Mar i t al St at us: 11. Hei ght : _______ 12. Wei ght : _______ 13- Educat i on ( hi ghest l evel compl et ed) : '____________________ ' 14. Di d you par t i ci pat e i n t he Kehoe st udy at t he Ket t er i ng Labor at or y? ` I f yes, what wer e t he dat es of t hat par t i ci pat i on: Dat es Fr om To Yes No 15. Pl ease expl ai n your par t i ci pat i on i n t he st udy ( how you wer e exposed t o l ead, how much l ead, et c) : __________________________________________________________________ 16. Di d you exper i ence or have you exper i enced any of t he f ol l owi ng sympt oms? Sympt oms Dur i ng your par t i ci pat i on i n t he st udy Si nce your par t i ci pat i on i n t he st udy Pl ease descr i be ( act ual sympt oms and when sympt oms st ar t ed) : _____ Numbness and t i ngl i ng i n t he ar ms or l egs Yes No Yes No Muscl e weakness i n t he ar ms or hands Yes No Yes No Muscl e t wi t chi ng i n t he muscl es of t he ar ms or l egs Yes No Decr ease i n si ze of muscl es i n t he ar ms or hands ( muscl e wast i ng) Yes No Yes No Yes No Numbness and t i ngl i ng i n t he l egs or f eet Muscl e weakness i n t he l egs or f eet ^ ( Dur i ng par t i ci p. ) ( Si nce par t i ci p. ) Yes No Yes No Yes No ___ Yes ___No Muscl e t wi t chi ng i n t he muscl es of t he l egs or f eet ___Yes No Yes No Decr ease i n si ze of muscl es i n l egs or f eet ( muscl e wast i ng) Change i n pi t ch or qual i t y of voi ce Yes No Yes No Yes No Yes No Di f f i cul t y chewi ng or swal l owi ng Yes No Yes No Di f f i cul t y speaki ng Change i n t he way you wal k Yes No Yes No Yes No Yes No Tr emor s Fr equent mood changes Memor y pr obl ems Fr equent muscl e cr amps Muscl e par al ysi s Yes No Yes No Yes No Yes No Yes No Yes No - - - - - - - - - - - - - - - - - - - - - - - - - - - Yes No - - - - - - - - - - - - - - - - - - - - - - - - - - - Yes No - - - - - - - - - - - - - - - - - - - - - - - - - - - Yes No Yes No Medi cal / Fami l y Hi st or y 17. Have . you or anyone i n your f ami l y been di agnosed as havi ng any of t he f ol l owi ng: Pl ease descr i be ( who, when di agnosed, associ at ed sympt oms, et c) : Di abet es Cancer Sei zur es Headaches Thyr oi d t r oubl e St r oke Br ai n t umor Sen i 1i t y Ki dney t r oubl e A11er gi es 3one f r act ur e ( st at e l ocat i on of i nj ur y) Chr oni c br onchi t i s St omach pr obl ems \ r t hr i t i s \ nemi a l out r ost bi t e ( st at e body par t of i nj ur y) ear t di sease ack pr obl ems i gh bl ood pr essur e ul t i pl e scl er osi s ar ki nson' s di sease Yqs . No Yes No Yes No Yes No Yes No Yes . No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No ^r ebr al pal sy Muscul ar dyst r ophy Tr emor s *" Pol i o Mot or neur on di sease * Amyot r ophi c l at er al scl er osi s ( ALS) Hunt i ngt on' s di sease Vi t ami n B12 def i ci ency Ot her Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No _ _Yes _ No 18. Have you ever had sur ger y? Yes No I f yes, pl ease st at e r eason f or sur ger y and dat es: 19. What i s your aver age i nt ake of al cohol (1 shot of l i quor , 1 gl ass of wi ne or 1 bot t l e of beer = 1 dr i nk) ? Fi l l i n most appr opr i at e bl ank: __________________ # dr i nks/ ____________ day, ____________ week, _____________ mont h Occupat i onal / Exposur e Hi st or y 19. Have you been exposed t o any of t he f ol l owi ng at wor k or whi l e i nvol ved i n hobbi es? ( For exampl e, exposur e woul d mean havi ng had ski n cont act wi t h or i ngest i on of var i ous subst ances or havi ng i nhal ed f umes or dust . ) Subst ance Pl ease descr i be ( dat es, nat ur e of exposur e, et c. ) : Lead Mer cur y Ar seni c A1umi num Manganese Acr yl ami de Hexane Tr i chl or oet hyl ene ( Tr i chl or , Tr i l ene) Per chl or oet hyl ene ( Per chl or , Per c) Met hyl n- but yl ket one ( MBK) Car bon di sul f i de Tol uene Met hyl ene chl or i de Car bon monoxi de I nsect i ci des Met al dust Sol vent s Gl ues Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Ot her subst ances ( t hat you may wor k wi t h or have wor ked wi t h i n your j ob or whi l e doi ng hobbi es) : ______________________________________ ___________________________ 20. Ar e you cur r ent l y wor ki ng? ___Yes ___No Occupat i on: __________________ 2V: Pl ace of empl oyment : _________________________________________________________ 22. Mont h and year j ob began: ______ i _______ / ______ 23. Br i ef l y descr i be your j ob t asks ( how you per f or m your j ob; t he subst ances you wor k wi t h, et c. ) : ____________________________________________________________ 24. I f not cur r ent l y wor ki ng, pl ease st at e r eason: 25. Mont h and year j ob ended: _________ / ___________ 26. Pl ease l i st your pr evi ous j obs st ar t i ng wi t h t he most r ecent one: DATES SUBSTANCES YOU JOB FROM: TO: JOB TASKS WORKED WI TH Thank you f or t aki ng t he t i me t o compl et e t hi s quest i onnai r e. Pl ease f eel f r ee t o gi ve a copy of t hi s f or m t o your per sonal physi ci an, shoul d he/ she wi sh t o cont act us. 0008304