Document qmGxNXq08qMgLLbbryjnBebrE

June 1, 1972 Hobert Woiuman, M.L-. Chester Cliiiic, Inc. 2120 St. Ciiiir avenue Clovelane, Ohio 44114 , Lear Doctor Woiumun: I am dealing with your letter of May 26 very briefly by reason of the fact that I have not recovered entirely from a recent severe illness, and, therefore, I am spemiui,:; only a snort time in my office ouch cay. I take* Ui- your queutaons in the order of the numbers. J. Tcoa line in the punts is not a permanent change. It disappears slowly. The amount of time repaired for its disappearance varies with the severity of the exposure to lead which induce'.'; it and also to the extent of the completeelimination ox this exposure. The time in any case is a matter- of months. 2, 3 1 4. vcute infections and organic damage oi any type complicates ant increases tue severity of an episode of lead noisoniny. In addition, any tyee of significant illness reinforces lead poisoning arc may have some efiect (usually hi...; ht)j a:-, a luie, n,,on the- rate u? wsiicfc lean is absorbed and txcreieo. tiii.au> types of illness such as diseases oi tire liver tend, enerally, to increase tn* susceuiibility of ir.diviour.jp to lead. There is very litt Ic ed,iini tive experience or experimentation to enable one to speak definitively on this matter. Very few cases of lead poisoning have beer stualeu with such care as io enable one to determine such effects as you steal. of in these qucstioi b. fe.i.i poison,hip. and lead intoxication arc simply two terms usee to denote the . s toxic effects of lead. you will see- in my article (t. am e n d os in two), the concentration of lead in the blood is in no sense diagnostic. High concentrations oi lead in the blood (0.03 su./lOO grams and u-.-warus) are merely indicative cf the iact that lead is being, or has been, adsorbed in potentially cangerous quantities. The diagnosis of load poisoning is made on the basis of tne clinical findings. This determination of lead in the blood merely tells you that the exposure to lead has, or has not, been sufficient to cause illness. The illness is interpreted as any other illness would be, ant it should not be c o n d u c e d that there is any means to actually prove the oiaehosis. In this instance ana in many others, one depends upon the juoimaent ox a physician to interpret the nature of the- illness. The best aavice 1 can give you is to make a thorough physical examination, to take a detailed history of the- exposure to lead, to have a determination of the ieaa in the blood which can be trusted, ana with this combined information, t^ uctermini, wnat is tat most likely ci.ust; the illness. Cordially yours, Hobert .i. Kehoe, MI .U.DL. Professor Emeritus of Occupational .Medicine a a S R A M S , M. D. r ' w o l d man ,m.d. A. M ATA, M.D. C H E S T E R C L IN IC , IN C . 2120 ST . C L A IR A V EN U E C L E V E L A N D , OHIO 4 4 U 4 May 26, 1972 241- 2267 Ro b er t A. Kehoe, M. D. Un iversit y o f Cincinnati C i n c i n n a t i , Ohio 2*5219 Dear Do ct o r Kehoe: I have r e c e n t l y become a f f i l i a t e d w i t h an i n d u s t r i a l p l an t where lead ex posure i s a m ajor problem , I have en joyed read in g yo u r r ecen t a r t i c l e s on lead in t h e Jo u r n al o f Occu p at io n al M ed ici n e and f ound them t o be ver y en l i g h t en i n g and h e l p f u l . Th er e a r e s t i l l s ev er al t h i n g s t h at ar e n o t c l e a r in my mind even though 1 have done a d d i t i o n a l r ead i n g . 1. Once a lead l i n e ap p ear s on t h e gums i s i t a perm anent change o r does i t ev er d i sap p ear ? 2 . Do acu t e i n f e c t i o n s o f any t yp e enhance t h e ab so r p t i o n o f l ead ? 3 . I f a p erson has a c t i v e h e p a t i t i s , would t h i s enhance o r d ecr ease the absorption of lead? 1. A r e t h er e any ch r o n i c co n d i t i o n s such as ch r o n i c c i r r o s i s t h at would enhance t h e ab so r p t i o n o f lead (and p r esu m ab ly i n cr ease t h e r i s k o f lead in t o x i c at i o n )? 5 . The more I have d el v ed i n t o t h i s p r ob lem , t h e more con f u sed I become as t o how one makes a d i ag n o si s o f lead p o i so n i n g , o r would i n t o x i c a t i o n be t h e b e t t e r t er m , e s p e c i a l l y when t h e blood lead t e s t s ar e i n t h e range o f 0. 08mg. p er hundred gram s, and t h e p a t i e n t has symptoms co m p at ib le w i t h e i t h e r a v i r u s i n f e c t i o n o r an acu t e g a s t r i t i s . K " 0007598 or. Robert A . Kehoe I would ap p reciat e the b en ef it o f your vast ex perience in t h is m atter and would a p p r e c i a t e bot h yo u r comments on t h ese o r r ef er en ces t o l i t e r a t u r e you would be aware o f where I could f in d t h i s in f o r m at io n . I a l s o would a p p r e c i a t e i t i f you would g i v e me yo u r t h o u g h t s on t h e m at t er o f s e t t i n g up an ad eq u at e scr een in g p r o ced u r e i n d i c a t i n g w hich t e s t s sh o u ld be used (CBC, an d / o r b lood l ead , e t c . ) and a t what i n t e r v a l s a p at ien t should be evalu at ed . Any h el p you can g i v e me w i t h an y o f t h ese m at t er s would be g r e a t l y appreciated. Si n c e r e l y yo u r s, \ RMW/ dcc cc Ro b er t M* Woldman, M. D. H h 000759$