Document bBwj4GXpY5x5xM1MJqOGx34qo

In t e r n a l m e d ic in e W ILLIAM H A RPER, M. D. JO H N W . STRIZICH . M. D. DO CTORS HARPER, STRIZICH AND M cM AHO N SU IT E 101, PRO FESSIO N A L, B U ILD IN G 3 2 4 FULLER AVENUE HELENA, MONTANA Te l e ph o n e 4 4 2 -2 3 2 2 , s November 12, 1964 Robert Swariberg,- Chairman Stats of Montana ' Industrial Accident Board . San Mitchell Building Helena, Montana rai Clai4 2193-A-51 O.D. American Bridge, Division of United States Steel Corporation Mr. Swsnberg; At tho request of the Industrial Accid^v^Board, I have examined Mr. f H | on October 6, 1966. Mr* gives me a history of having done some burning, during a considerable period of time, around red lead paint in his occupation as a welder. He states that he was burning around this paint part time from December 1965 to March 1966 and that the situation was quite bad during a six week period of time In March and April 1966. He states that ho developed stomach cramps sometime in April. He apparently developed severe stomach cramps sometime in Arpil. At that time on examina tions done l ' j several doctors, revealed the presence of an anemia, some stippling of his red blood cells as well as a lead line noticed on bin gums. J He states that a picture was taken of this lead line by one of the doctors in Great Fells. Seminations of his urine for tho presence of lead by n 'arnica of the hospital was markedly elevated. Ho tells me that ho feels t a* it uas ocmctvhero in the neighborhood of 14.6. Ho was treated with tho chelating agent called "I&drate" and states at tho time of diecharge his lead level was 'down to 7 * Ho states that it was last run in August of this year and at that timo it was down to 4 6. .. At tho present timo Ills chief symptoms .are related to pain in his thighs and forearms when ho is forced to use them to any extent and that ho tires out quite easily after about six hours of work. Physical Examination: Ilia mouth did not reveajgfcho presence of any .lead lino at this timo. Ko does not show the presence of ary severe j^oriphcral. neuropathy such as wrist drop or ankle drop. Tho roste of his physical examination was " not remarkable. --- - ~ ---!--- Laboratory studies were done on this patient in an effort to delineate his difficulty. An electrocardiogram was completely within normal limits. Urinalysis showed a specific gravity of 1.026 and there was no evidence of albumin, sugar. tir fr John W. Strizieh, 2bn , P r o t Bldg., 324 Fuller Avo., Helena, Mentana, dtd yv 12, 1966, ro! CROSS MUTE, Terry, Cl # 2193-A-51 O.D., PAGE 2 white C0 II3 or red c e l l s detected on microscopic examination of his urine. His unite blood cell count was 0,050 with a normal differential count. IIi3 hematocrit was 33 volume percent and the:sedimentation rate of his blood was 4 millimeters por hour. A 24 hour specimen of his urine was cent to the stato laboratory for analysis for lead. This revealed the presence of .22 milligrams per liter of lead at a corrected specific gravity to 1.024. Cliestlxtray was within normal Halts ana there is no radiographic evidence of excessive deposition of load in M s bones. There are several things about Mr. that suggest the presence of lead intcod.cation. The first thing is a mild anemia with a hematocrit of 33 volume percent. Normal levels for a man of his age should be 42 to 45 volume percent, ha did nc^nctico any_stippling of his red blood cello in his peripheral emaar, `but this is not,nnconaai after these people have been treated. He still has a very slightly elevated urinary excretion of lead which does not surprise me. < \ Although one can frequently detect the presence of excess lead in the bones in children where it is deposited in the area of bone growth, this is extremely unusual in adults, and X am not surprised that we do not see any radiographic evidence of excess lead deposited in the bones. Ledd poisoning in the human being may come about in a variety of ways. Probably the most common causa is to be found among children in poorer fmilios, living in older homes where the paint and plaster of the walls is loaded with lead compounds. Some of these children develop the habit of eating the paint and plaster and can develop extremely severe cases of lead indication. Another quite common method of acquiring this-disease is to be found on tho burning of load compounds. Probably the most notorious product to be incriminated in this situation is the burning;of' storage batcries. It Is also obvious that weldors who are around burning lead can accumulate a sufficient amount through their "respiratory tract to produce symptoms of severe load intoxication. However, the lead is absorbed into the human body, it is eventually deposited in tho bc:ac3 from which it is excreted from the body very slowly. It is generally a curaulativo disease in that the exposure is generally repeated and ovor a y largo period of time before the patients become symptomatic. Tho oyKiptoms of lead poisoning vail generally zaanifeot themselves in three systems of tho body. First in the blood that these patients almost invariably bccomo anemic. They have's great deal of changes in the red blood coll3 with a peculiar locking Gtvrollng which can bo detected under the microscope. These abnormal red colic e o n to bo more fragile than normal and as a consequence tho patient develops a mild to moderate degree of anemia. The second system Involved is the gaotro- intestinal tract in that these patients not uncommonly will develop severe abdominal craaps which can be a difficult problem in controlling. Hie third system involved is the central nervous system. Hie intoxication may mniifcst itself in tho central nervous system by tho production of convulsions and tho like. Thcco people who convulse from lead intoxication quite generally have a poor prognosis. The diesaoe also produces a peripheral neuro 'tfixicihy and this generally involves the muscles *,;hich do the most work. The classic manifestation of this is the severe wrist . drops which are occasionally seen in painters who obviously use thoir wrists a great deal in their work* Those people, practicing poor oral hygiene will occasionally Gcyclop a load line which is a bluish :discoloration at the margin of the tooth and. tee gums* .- Ltr fr John Vi. Striaich, M.D., Prof Bldg., 324 Fulloa Avo., Helena, Ilont., Hov ? 1966, ros Tony, Claim # 219S-A-51 O.j. PAGE 3 Baring- the past ton to twelve years vo have been using drugs which are known as chelating agents which, fora a close bond with things such as load, arsenic cad.the like. These compounds era injected in the body and they combino tho lead end are then emcroted In tho urine* At the present time Hr. docs h a w a mild degree of anemia which very likely could be related to lead inic:cation. Eo also chow3 evidence of peripheral neuropathy involving both his forearms as as his thighs which'would bo in the muscle groups most caumcrJy -used by a man who has done hia typo of work in tho past. .1 suspect that I-Ir. adequately treated to the.prosent time and the object of treatment, of course, is to mobfi2ao andexcrete as much " w ;; lead as possible until tho patient becomes completely asymptomatic. It is - always possible that after treatment has been discontinued that tho patient r may gradually rcaccuaulato an increased amount of load in his tissue which has been mobilised from Iiis bones and that his Gpnptoxns may recur. Mf { M /' v; .at is ry opinion that H r . h a s very definitely stiffored from lead , intoxication probably roiatod to hia Job of burning red lead. I fool that ho - has probably- boon adequately treated to tho present time, but the possibility docs crdLct that ho may have to bo retreated la tho future. I fool that he is '| still suffering from como residual load neuropathy involving the thighs and forearms end that it may bo a considerable period of time before this completely clears up. If thcro is ary further information you would like, please do not hesitate to contact mo, - - Sincerely,