Document kDLKQE2oDjz9wYx8Ld7EegMNb

fftALT'" Boston University Medical Center School of Medicine 80 East Concord Street Boston. Massachusetts 02118 Department of Neurology Office of the Chairman (617) 247-5136 December 13, 1982 Stanley Sulkes 5822 Wyatt Avenue Cincinnati, Ohio 45213 Dear Mr. Sulkes: As Chairman of the Department of Neurology at Boston University School of Medicine, I am interested in studying the effects that various substances have on the nervous system. Last month, I met with Dr. Robert Kehoe in order to discuss the research he conducted at the Kettering Laboratory in the area of the metabolism of lead as well as raise the question of the possible long-term effects from that exposure. He gave me permission to contact you and the other participants in that study where lead was ingested in the form of an aqueous solution of lead salt or inhaled in the form of airborne particulates. I am interested in learning of your current health status and have enclosed a questionnaire for that purpose. Dr. Kehoe was able to give me the names of all the participants in that study but was uncertain of six individuals' current addresses. They are as follows: Floyd Creech, Steven Balog, Martin Riehle, Ivan Ferneau, Harvey Reed, and Donald Hayes. Should you know of their whereabouts, I would be most grateful if you could send me that information when you return the enclosed questionnaire. I am most grateful for your cooperation in filling out the enclosed form and returning it to me at your earliest convenience. I will keep you informed of the jr assistance. Department of Neurology RGF/cg cc: Robert A. Kehoe, M.D. QUESTIONNAIRE TO PARTICIPANTS OF KEHOE STUDY AT KETTERING LABORATORY oday's Date: -/ Background Information 2. Name: 3. Address: 4. Telephone #: 5. Soc. Sec. #: 6. Date of Birth: 7. Place of Birth: 8. Sex: ____________ 9. Race: 10. Marital Status: 11. Height: _________ 12. Weight: _________ 13. Education (highest level completed): '________________________ ______ 14. Did you participate in the Kehoe study at the Kettering Laboratory? If yes, what were the dates of that participation: Dates From To Yes No 15. Please explain your participation in the study (how you were exposed to lead, how much lead, etc): 16. Did you experience or have you experienced any of the following symptoms? Symptoms During your particiipation in the study Since your participation in the study Please describe (actual symptoms and when symptoms started): Numbness and tingling in the arms or legs Yes No Yes No Muscle weakness in the arms or hands Yes Muscle twitching in the muscles of the arms or legs ___ Yes Decrease in size of muscles in the arms or hands (muscle wasting) Yes No No No Yes No Yes No Yes No 0008801 -i- N9840.01 Numbness and tingling in the legs or feet Muscle weakness in the legs or feet (During particip.) (Since particip.) Yes No ------ - Yes -- No -i ___ Yes No Yes No Muscle twitching in the muscles of the legs or feet ___Yes ___ No Yes No Decrease in size of muscles in legs or feet (muscle wasting) Change in pitch or quality of voice Yes No Yes No Yes No Yes No Difficulty chewing or swallowing Yes No Yes No Difficulty speaking Change in the way you walk Yes No Yes No Yes ___ No Yes No Tremors Frequent mood changes Memory problems Frequent muscle cramps Muscle paralysis Yes No Yes No Yes No Yes No Yes No Yes ___ No Yes ___ No Yes ___ No Yes ___ No Yes No Medical/Family History 17. Have you or anyone in your family been di agnosed as having any of the following: Please describe (who, when diagnosed, associated symptoms, etc): Diabetes Cancer Seizures Headaches Thyroid trouble Stroke Brain tumor Senility Kidney trouble A11ergies 3one fracture (state location of injury) Chronic bronchitis Stomach problems \rthritis \nemia lout rostbite (state body part of injury) eart disease ack problems igh blood pressure ultipie sclerosis arkinson's disease 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 Yes No -2- KE 0003302 Cerebral palsy Muscular dystrophy T remors ~ Polio Motor neuron disease ** Amyotrophic lateral sclerosis (ALS) Huntington's disease Vitamin 812 deficiency Other Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 18. Have you ever had surgery? ___ Yes No If yes, please state reason for surgery and dates: 19. What is your average intake of alcohol (1 shot of liquor, 1 glass of wine or 1 bottle of beer = 1 drink)? Fill in most appropriate blank: # drinks/ day, week, month Occupational/Exposure History 19. Have you been exposed to any of the following at work or while involved in hobbies? (For example, exposure would mean having had skin contact with or ingestion of various substances or having inhaled fumes or dust.) Substance Please describe (dates, nature of exposure, etc.): Lead Mercury Arsenic A1uminum Manganese Acrylamide Hexane Trichi oroethylene (Trichlor, Trilene) Perch! oroethylene (Perchlor, Perc) Methyl n-butyl ketone (MBK) Carbon disulfide Toluene Methylene chloride Carbon monoxide Insecticides Metal dust Sol vents Glues 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 Other substances (that you may work with or have worked with in your job or while doing hobbies): 0003303 -3- 20. Are you currently working? ___ Yes ___ No Occupation: ______________________ 2V: Place of employment: ____________________________________________________________________ 22. Month and year job began: i/ 23. Briefly describe your job tasks (how you perform your job; the substances you work with, etc.): ________________________________________________________________________ 24. If not currently working, please state reason: 25. Month and year job ended: / 26. Please list your previous jobs starting with the most recent one: DATES SUBSTANCES YOU JOB FROM: TO: JOB TASKS WORKED WITH Thank you for taking the time to complete this questionnaire. Please feel free to give a copy of this form to your personal physician, should he/she wish to contact us. K& 0008304 -4-