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  1. 1. GET THE LEAD OUT! Dorothy Merritt, MD
  2. 2. Lead –Who Is Affected The Most Blood-brain barrier is not complete until 6 months of age so lead can be absorbed by CNS of fetus and young child ( lead crosses placenta). Absorption of lead is estimated to be as much as FIVE TO TEN TIMES GREATER in infants and young children than in adults. Needleman H. Ann Rev Med 2004;55:209-222
  3. 3. Lead: Where does it come from? <ul><li>Soft vinyl lunchboxes- found to contain more than 90 times legal limit </li></ul><ul><li>Candy imported from Mexico </li></ul><ul><li>Imported children’s jewelry </li></ul><ul><li>Leaded gasoline- currently used in farm machinery, boats, racing cars </li></ul>
  4. 4. Lead: Where does it come from? Billions of tons of lead has been unleased into the environment the last 100 years due to paint and gasoline additives that have now been banned in the US and Europe <ul><li>Air - indoor dust exposure greater than soil or paint chips </li></ul><ul><li>Water - 20% of daily exposure “lead-free” brass fixtures 5-7% lead </li></ul><ul><li>Imports - lead-glazed dishware, leaded crystal. Lead solder in imported canned food,foods from Mexico, China, Spices, Wine </li></ul><ul><li>Medicine - Ayurvedic and foreign medicines </li></ul><ul><li>Vinyl mini-blinds imported before 1996 </li></ul><ul><li>Polyvinyl products - cords covering wires </li></ul><ul><li>Cosmetics - lipsticks </li></ul>
  5. 5. Lead in Wine <ul><li>For 432 wines tested in the bottle, the lead in domestic wines ranged from 1 to 521 parts per billion, with an average of 41. The level in imported wines ranged from 4 to 673 parts per billion with an average of 94. </li></ul>
  6. 6. Lead glaze used on plate imported from Portugal and sold at American Home Furnishings
  7. 7. Fatal Case of Lead Poisoning from Injestion of Jewelry <ul><li>A 4-year old male died of acute encephalopathy 3 days after being admitted for intractable vomiting, stomach pain, and listlessness. </li></ul><ul><li>A metal charm, seen in his stomach on radiograph and was later found to contain 99.1% lead. </li></ul><ul><li>Reebok later recalled 500,000 of these charms, which they had given away free with pairs of girl’s shoes. </li></ul><ul><li>MMWR. March 23, 2006 / 55(Dispatch);1-2 </li></ul>
  8. 8. Occupations at risk for lead toxicity <ul><li>Electricians, plumbers, painters, </li></ul><ul><li>ceramicists, </li></ul><ul><li>Munitions specialists, paint and ink manufacturing, etc. </li></ul><ul><li>Electrical tower and generating station maintainance . </li></ul><ul><li> </li></ul>
  9. 9. Total = 12,712 Section 44 of The Construction Chart Book, Fourth Edition, December 2007 - Distribution of workers with BLLs greater than or equal to 25 µg/dL, by industry, 2003-2004
  10. 10. Number of workers with BLLs greater than or equal to 25 or 40 µg/dL , by detailed construction sector, 2003-2004 1,051 406 412 92 70 41 41 39 14 Section 44 of The Construction Chart Book, Fourth Edition, December 2007
  11. 11. NOEL N o O bservable E ffect L evel <ul><li>Lead is unique as a toxicant in that there is agreement among these governmental agencies as to its toxicity </li></ul><ul><li>CDC Centers for Disease Control </li></ul><ul><li>ATSDR Agency for Toxic Substances and Disease Registry </li></ul><ul><li>EPA Environmental Protection Agency: </li></ul><ul><li> </li></ul><ul><li>“ There is no toxic threshold for lead. This means there is no measurable level of lead in the body below which no harm occurs.” </li></ul>
  12. 12. Circulation 2006;114;1347-1349 Tim S. Nawrot and Jan A. Staessen NHANES DATA <ul><li>“ Low Level Environmental Exposure To Lead Unmasked As Silent Killer in US” </li></ul>Editorial in Circulation 2006 with Latest NHANES Study On Lead And Vascular Disease
  13. 13. Lead Toxicity-Early Symptoms <ul><li>Diffuse muscle weakness </li></ul><ul><li>General fatigue/lethargy </li></ul><ul><li>Attention deficit/ irritability </li></ul><ul><li>Myalgia </li></ul><ul><li>Joint pain/arthritis </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Unusual taste in mouth/change in taste of food </li></ul>
  14. 14. Lead Toxicity Symptoms <ul><li>Headache </li></ul><ul><li>Insomnia </li></ul><ul><li>Irritability </li></ul><ul><li>Diminished libido </li></ul><ul><li>Weight loss of 10 lbs or more without known cause </li></ul><ul><li>Tremulousness </li></ul>
  15. 15. Lead-Related Symptoms <ul><li>Personality Changes </li></ul><ul><li>Peripheral neuropathy in extensor surfaces- most common neurological symptom in adults </li></ul><ul><li>Abdominal pain/cramping </li></ul><ul><li>Nausea/vomiting </li></ul><ul><li>Short-term memory loss </li></ul><ul><li>Depression </li></ul>
  16. 16. Lead-Related Symptoms <ul><li>Incoordination </li></ul><ul><li>Paresthesias </li></ul><ul><li>Constipation </li></ul><ul><li>Inability to concentrate </li></ul><ul><li>Impotence </li></ul>
  17. 17. Lead Toxicity in the US 2010 Blood lead levels: NHANES STUDIES (Reflects 30-60 day exposure) Bone lead levels : NIH STUDIES (Reflects LIFETIME exposure) Measured by urine “challenge” test
  18. 18. NIH Study Lead in Bones Adult Implictions <ul><li>Lead stored in the bones from earlier in life is released into the blood and soft tissues from 4-10x increased turnover of bones associated with normal aging </li></ul><ul><li>90% of all the lead you have been exposed to is IN YOUR BONES </li></ul>
  19. 19. Populations at risk for lead toxicity from increased bone turnover <ul><li>Menopausal women/Andropausal men </li></ul><ul><li>Hyperthyroidism in either sex </li></ul><ul><li>Cisplatin chemotherapy </li></ul><ul><li>Patients with osteoporosis or osteopenia </li></ul><ul><li>Vitamin D deficiency-50% of population </li></ul>
  20. 20. Cardiovascular Disease <ul><li>Those in the highest tertile of blood lead: </li></ul><ul><li>( 3.63-10.0 µg/dL ) vs (2ug) </li></ul><ul><li>2.5 times risk for stroke mortality vs 1.51 </li></ul><ul><li>1.89 times risk for myocardial infarction mortality vs .81 </li></ul><ul><li>1.70 times risk for cardiovascular disease </li></ul><ul><li>mortality vs .55 </li></ul><ul><li>Circulation 2006;114:1347-1349 </li></ul>
  21. 21. SO WHAT DO YOU DO ? <ul><li>Avoid new exposures </li></ul><ul><li>Keep bones healthy </li></ul><ul><li>Reduce medical risks of bone turnover </li></ul><ul><li>Get your blood level of lead checked </li></ul><ul><li>If your blood level is above 2 and you have symptoms of lead toxicity, you may qualify to do “chelation” which removes the lead </li></ul>
  22. 22. What is “Chelation” <ul><li>EDTA chelation has been FDA approved for treatment of lead toxicity since the 1950’s </li></ul><ul><li>Serial IV treatments with EDTA remove lead from the bone and the tissues </li></ul><ul><li>Ask your doctor for a brochure on chelation treatment to explain all the things it can do for you or go to </li></ul><ul><li> </li></ul>
  23. 23. Check list for heavy metal symptoms used in our clinic
  24. 24. <ul><li>Dorothy Merritt, MD </li></ul><ul><li>Mainland PCP Chelation Center </li></ul>