Document pBv0qVkxG3w46ynea6RzXXN3a

FILE NAME: Uniroyal (UNIR) DATE: 1957 Dec 6 DOC#: UNIR026 DOCUMENT DESCRIPTION: Letter to the State Board of Workman Compensation from Dr. John Wells RE Mr. Larkin Houston JOHN S. WEU5. M. O. I JEFFERSON OTREET NEW NAN , GEORGIA T C L tF H O N I 233*031 I 6 Dscerr.bar 1957 State Soar'd or Workmen1s C0Hio2n.saTi.00. u9^ Labor Building " 254 Washington .Street, S.W. Atlanta, Georgia Re: Mr. Larkin Houston This 5y year old utility ran in the weaving division of the Asbeston M ill at UniRoval was first hired in May o* 19^9. It has been seventeen yars a"d three months since his original exnosure. He has a total dust exnosure of ^8.3 MPPCFY. ,, .\r. r.ouston was first seen m 19 57 and stated at that time that ne was entirely well. His oast history was remarkable only in that he had_sustained a fracture of his nose in 1935 , and had been'left with*a deviation of the nasal septum which, he stated, created no difficulty. Physical examination m 1957 revealed a blood pressure of 110/70 and completely normal heart and lungs. There was no clubbing. He has been seen annually since that time; and in Aoril of 1959, stated that ha had had a good year but noted that his wind seemed a little shorter on heavy exertion and that he gave out a little more easily than in orevious years. Physical examination was normal. push heavy objects or exert himself. During the cast year, this sense of dyspnea has worsened and patien ..as found himself losing increasing amounts of work-time because of a sense of staariilv diminishing strength, energy and stamina and increasin dysor.ea. _ Since July of 1967, he has found himself becoming short of breath cuite easily and in the course of his dailv job which has required con siderable lifting and pushing of heavy objects. He notes that if walks on even a straight and level surface for any oeriod of time, his breathi: becomes orogressivalv.Sorter. ' " He has been coughing in the morning for the past several years and has observed tnat the morning cough has become more severe in the oast year or two and has become productive of small to moderate amounts of dark, sometimes yellowish, scutum which has never contained blood. SC-140 oa8 Hr. Larkin Houston -2- Ha has begun to cough more, during the. day but -me -- _ a has not produced sputum in significant decree. H"e. has...b.e.a.n..unaware o' zz.7i& or rartlir.r witrhir* *hs ch?c*. --mere have bean occasional oarastemal aching oains wb.-'ch 'av bear, related to hard breathing but not soecif icallv to exar'-^o^ " -~d t..ara has bean no radiation of pain. ' """ ""~ He has become aware of his heartbeat following exertion in the la<*i w .o..ths and notes t.nat it tends to pound in a regular fashion. Ha has had no dependent swelling but observes that 1"`c l?c-s t-' Tr.ora easily than they formerly did. They do not ache Gn xerticn. " . - ?iL`?a j!:V ' of 19?7 ha begun having bilateral uooer na-*t=^?i acning ,,iscomrort which seems occasionally to radiate into the region. This ache has been relieved bv rest. ' ,, "?-c^usr of increasing fear o? coronar^ arterv disease he y=H an ixercise_ Tolerance Test on 2 November 1967. At this tim 2? ^yT-sdrnill for three minutes at a rate, of two miles ter hour.' "burin ;-r'--r'u m_nute he became moderately increasing dvsnneic, but exoarienc no cnest pain and was not observed to cough. ' - . Immediate oost-exercise, two and five minute electrocardiogram A=re ootamed and showed no significant ST-T wave chances. ' Exercise cardiogram was interpreted as negative and t>"* n*o~mato was given to the patient. " " l--a Ar*^ual physical" examinations since 1957 have revealed the nasal sec -u... to b= deviated to tne right and partial obstruction to breathing -.r^u-.n the le*t nostril. ihere has been no evidence of sinus d;eaas3 manifested by sunra-sinus tenderness. " Respiratory excursion and descent of bases to oarcussion- has been adequate and remains so. The lungs have been consistently clear xcaot m August of 1937 when some diminution of breath sounds over th s anteriorly and posteriorly was noted. There have been no rales. The cardiac examination has been consistently normal and t* oo"d ortic sound has always been normally louder than the second oulmonic "* ' our.d. However, again in 1967, A2 was noted to be only slightly greater t..an P2. There have been no murmurs or evidence of oeri^he^al a^te-'-'o- sclerosis. . - ----- - Urinalyses have been consistently normal over the oast ten years. . -3 i also, have white counts and differential examination o^ t1' stained blood. ` backed corouscular volumes have varied from 49 in 1957 to 50 1957. The hemoglobin has henerally staved in the neighborhood of 14.7 grams oar cent. ' [0 ill 5C1^0o o 3 ,arl:in reuston -19. has tsr.dftci to hava .c 6.S ~illior. uni TO 5.53 in 1962 ti'-- r.crf. than usual nur>.ber' cf r?.d calis 1957 and bes steadil'-' but slovl-- dacreas q-,,4 t_ chest y-rav3 nbia.ir.ar! during this decade have beer. consistar.i nc~~al 7.XC85T rerhaos -or a vary slight decrease in the^vertical diaretsr of'his chest ir. the. oast three years. Slight irregular!t" of the lert cardiac outlir.a b.as aroearad as has a varv snail tenting adhesion ir. tre r.id portion of the left dr.aor.rac~.. ~ha vascular rark ires rarain distinct although a vary rir.i~.al _ __ ncdularitv~is' r.aking" its appearance ir The Icwar radial right lure field. These x-rav charges are not yet diagnostic of" oulr.orary asbestesis as we have iaarrad to recognise i. -...'--is -r-.-il-l,, -b-u-t are ouita susoic.icu* and cc~.bir.ad -.rich cthar findings (noted below) render suer a diacr.es: Vital capacities have chanced very little since 1962 although he y,a., "ou--'J= weight ar.d have decreased fro~. 3.1 liters to 3 lirsrsT Toth values "are equivalent to 75 per cent of predicted renal. Forced vital capacity at 3.5 seconds has decreased fron 2.57 to 1.22 liters or from 83 to"53 per cent of oredicted nomai. "'he forced exoiratorv volune at 1.0 seconds has r.ot chanced as c'reatl'-'''"and*has decreased" fron 2.9U to 2.^7 liters or fron 92 to 82 oer cent of oredicted nomai. !ie continues to have satisfactory ~e.yi~.al exoiratory flow rates and ~.a:<inal raid exoiratcry flow rates, althcuph there is again a decreas* frer. 5.3 to 5.9 and fron 3.5 to 3.3 liters oer second. :T'!s naxinal Ventilator'' free has decreased fron 1.70 to 1.15 liters or fron 119 per cent of predicted nom.al to 85 per cent. ii-c ?lveolar ventilation indices has shewn a steady ^decrease fron l.5 to~. although the latter figure is not in and. of itself pat..osno. m. onic bv anv m.a.3r.s of obstructive d2.ss3.sa* 01 ..H W Tha. significant observation from these values is that he^continue no hav""nomal'ventilatorv ability without evidence of significant exp ratorv obstructive disease. There is, however, an increasing decremen 4,, viiai caoacitv and naxinal voluntar'/ ventilation values. w.-g ^se.-4Uei voTunes -calculated as percent of total lung capacity (October 1957) are 25.1 and 25.8 per cent. For a nan of his ace and hoc u-'-ace a~ea, the oredicted value is 30.8 per cent. Aram, it can be Sc that there is no evidence at this tine of significant er.physana or ob structive difficulty. defect is more that of a restrictive defect and this also der.o: strated graphically or. his spirograns. 5Cl40oJ0 Mr. Larkin Houston _ lh October of 1957 , he. received numerous other blood gas studies. , seven r.ir.ute oulmonary .nitrogen emotying rate '-.'as performed ar.c shoved 1.2 per cent nirrcver. at seven minutes. This test suggested r.o''~ mixing of the ir.seired rases. ----- His arterial oartial orsssure of ox't;e follow'nm rirtia*' r>i-"T*c breathing of 100% oxygen '.-.'as 600 mi. of mercury" "'-'" .....* 3ready state-resting carbon nonoxide dif^us^on v --, and yielded values of 11.3 8 and 11.7 nl. of carbon monoxide oer~r.ir.ute*'> 'r.n o~ w.5,,cuv'v * ~ * Minute volumes of ventilation on these, tests were 8550 and 8120* and minute alveolar ventilation was 5120 and 480 0 ml. par minute."-" ' The. ratio of dead soace volume to tital volume was 0.31 and 0.32 values again suggesting an absence, of significant obstructive vert''la-c~ de-f-e--ct*r% Physiological dead snace on these two examinations was 135 and 1^8 mi. .inara some evidence of alveolar hyperventilation manifested by partial pressures of oxygen in the alveoli'ofll4.2 and 115.8'. ' . . The K "-- ssure differences were. 45.9 and U3.5 mm. of mercurv and nis arterial oxygen saturation was 92.2 and 92.2 oer cent on the. two diffusion studies. . These studies are. interpreted as indicating an alveolar-canillary --on defect resulting m less than normal arterial oxygen saturatic Ls able above, ... . obviouslv being able to main- t m s increase or.lv at the. expanse of increasing work expenditure and '"at- Houston has shown a moderately accelerated downhill course during the last twentv-four months, as noted subjectively in his histor , Although there are a physical findings ar.d only early roentge.r o. findings to validate his sS'ynotonatic complaints, the ohvsiolopical funcct: tests do provide a concret comolaint. PI "rnrjviftc C p ,-prs 1. Pulmonarv asbesto: f a) restrictive, ve: b) A.lveolo-caoillary r'c arterial cxvgen u: -5Ci^03ol w rdcin '-'cus to 5- i. Deviated nasal P.i.r.T *D2.^1^"^-2.1 *?.d?s, bsr.^n 't)tu rt 5CI40o G2