|LEAD Action News Volume
12 Number 3, May 2012, ISSN 1324-6011
Incorporating Lead Aware Times ( ISSN 1440-4966) and Lead Advisory Service News (ISSN 1440-0561)
The Journal of The LEAD (Lead Education and Abatement Design) Group Inc.
Info Pack - Case Management After Earlier-in-Life Lead Poisoning
By Elizabeth O'Brien, BSc, Grad Dip in Educational Studies (Health Educ’n), Manager, Global Lead Advice & Support Service (GLASS) run by The LEAD Group Inc. Australia
The LEAD Group is a Health Promotion Charity aiming to eliminate lead poisoning globally and all the information we put together in these Info Packs has been collated or written by myself or volunteers.
It is ALWAYS useful to know the current blood lead level even when you suspect that a person is no longer exposed to much lead today. A blood lead test result can demonstrate that despite no obvious sources or pathways of current lead poisoning, lead is indeed currently being taken up. Additionally, the movement of lead out of the bone stores and back into the bloodstream is a complex business and not all the provocations for that movement are fully understood. So in every situation where a person may have been lead poisoned earlier, there should always be a blood lead test done now.
Anyone who has ever had a job or hobby involving lead could very usefully fill in the questionnaire at Medical_Evaluation_For_Lead_Exposure_Modified_by_The_LEAD_Group_20101102.pdf as much as you can and take it to a doctor to complete. A blood lead test result can demonstrate that despite no obvious sources or pathways of current lead poisoning, lead is indeed currently being taken up. Additionally, the movement of lead out of the bone stores and back into the bloodstream is a complex business and not all the provocations for that movement are fully understood. So in every situation where a person may have been lead poisoned earlier, there should always be a blood lead test done now, measures taken to determine if recent lead exposure is likely, clean-up if so and then a retest of the blood lead.
Depending on the result, and the person's (or other family members') known previous blood lead results, and the known history of lead exposure, there will be differing recommended responses in following up the current blood lead result.
The official policy coming from all the doctors and professors on The LEAD Group's Technical Advisory Board is that apart from nutritional intervention and identifying sources and removing the sources or removing the person from the sources (in order to prevent further poisoning), nothing else can safely be done for a lead poisoned person unless they need chelation because the blood lead level of a child is above 45 µg/dL or of an adult is above 70 µg/dL. This position is well-supported by the following guidance documents from the United States - the centre of the universe when it comes to lead poisoning prevention policies:
1. Table 3.1. Summary of Recommendations for Children with Confirmed (Venous) Elevated Blood Lead Levels, and Table 3.4. Schedule for Follow-Up Blood Lead Testing in "Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention" at http://www.cdc.gov/nceh/lead/CaseManagement/chap3.pdf (also accessible via www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm)
2. Table 1. Health-Based Management
Recommendations for Lead-Exposed Adults and Table 2. Health-Based Medical
Surveillance Recommendations for Lead-Exposed Workers in "Recommendations
for Medical Management of Adult Lead Exposure" by Michael J. Kosnett;
Richard P. Wedeen; Stephen J. Rothenberg; Karen L. Hipkins; Barbara L. Materna;
Brian S. Schwartz; Howard Hu; and Alan Woolf, National Institute of
Environmental Health Sciences (US) (11/4/07) at http://www.medscape.com/viewarticle/554718_print
I have the pragmatic approach that, IF you can find a doctor you trust (preferably one who has experience treating lead poisoned people), then you should work with them to further manage the blood lead level and possibly get some of the lead out of the body, in the hope that you might do no harm and you might reduce the risks of the various adverse health effects associated with elevated blood lead levels.
To this end, I have noted in the database, every doctor who has ever been of use to one of our inquirers, and I advise people to see one of these doctors as well as any doctor trained by ACNEM (Australasian College of Nutritional and Environmental Medicine) to carry out chelation therapy and/or urine chelation challenge testing. For example, Dr Emmanuel Varipatis, YourHealth Clinic at Manly, ph clinic 0299777888.
ACNEM's website has a list of graduates of the ACNEM Primary Course - which covers the nutritional, environmental and biochemical factors in physical and mental health. State Referral Lists (in alphabetical order of suburb) of doctors or dentists including those who do chelation are at http://www.acnem.org/modules/mastop_publish/?tac=23 - for instance, YourHealth Clinic at Manly (ph 0299777888 - www.yourhealth.com.au) has three other chelating doctors on the ACNEM list: Dr Michael Beilby, Dr Joachim Fluhrer, and Dr Peter Lewis.
As for the extra-hard cases of people who weren't blood lead tested at the time of their lead exposure, we always recommend having a blood lead test NOW to determine that the worst lead exposure has indeed ended - as demonstrated by a blood lead level below 2 µg/dL - and secondly, if baby teeth have fallen out and are available, these can be sent to the NSW Health Department lab at Lidcombe (ph 0296460424). As of June 2005, Lidcombe lab has offered tooth lead testing to the public. The cost at that time was $40 per tooth, aim is one week turnaround, there is no interpretive report, no identification of the tooth by a dentist and no guarantee that the lead is not on the outside of the tooth due to contamination in storage or transit. As at May 2008, for less than 10 samples the cost is $40 per tooth but the minimum invoice is $100 so people are best to send at least 3 teeth in one consignment.
Thirdly, if a person happens to be going to the United States or Canada, or if they can convince anyone to put up the funding to get Australia's own bone-XRF machine working again, (we're hopeful that a Melbourne GP will organise to import one into Melbourne early next year) they can undergo x-ray fluorescence (XRF) testing of their bones for lead. Contact details are:
Fourthly, I refer people to an ACNEM-trained doctor or dentist who knows how to interpret and respond to the results and who will carry out urine chelation challenge testing.
Once a person has been found to be lead poisoned, isotopic fingerprinting is an invaluable tool in identifying the mine source and to an extent the pathways of the lead exposure. See for example "Report on Lead Isotopic Analyses of Samples Associated with the Esperance Lead Investigation" by Access Macquarie Limited: Professor Brian Gulson & Michael Korsch, CSIRO Division of Petroleum Resources, at www.health.wa.gov.au/envirohealth/home/docs/Draft_DoH_report_22_5_07_de-identified.pdf
Contact (now retired) Professor Brian Gulson, Professorial Fellow, Graduate School of the Environment, Lead Working Committee of the NHMRC (2008), Head of The LEAD Group's Technical Advisory Board, PH 0298507983.
Fifthly, if there is a current blood
lead level above 2 micrograms per decilitre, or any elevated heavy metal level
in hair, nails, teeth, urine or blood, The LEAD Group sells a heavy metal test
kit which involves the client or their health practitioner or knowledgeable
public health officer sampling any of a range of sample types in the home or
relevant hobby or workplace, eg soil, dust wipes, drinking water, paint,
jewellery, ceramicware, toy paint, etc, and sending the samples to a lab for
analysis of the specific heavy metal/s you are concerned about. The 8 sample
Comprehensive kit costs $250 for testing just one heavy metal in each of the 8
samples. You can see some Rosebery-specific info about our Heavy Metal Test Kits
The addition of the second (or third metal) to be tested for each sample, adds $9 to the total price of the kit. And as mentioned on the Tasmanian Times website, there's a discount for bulk testing, such that if you want all 8 samples in the Comprehensive kit tested for five metals, the price is $450, and for both samples in the Basic kit to be tested for five metals, the price is $172 (compared to $100 for testing for only one metal and $9 for each additional metal, per sample).
Lastly, having advised so many people who have to deal with earlier lead poisoning, I have found that many of them benefit from being in an egroup with other people who are in a similar situation. Egroup members can email all the other members via one simple email address, and ask each other questions and relate their case histories in order to get support and advice on whatever issues are relevant at the moment. The following egroups have been set up for this purpose and you are very welcome to go to the website and join (using your YahooID), any that are relevant:
1. LeadWorkers E-group http://health.groups.yahoo.com/group/LeadWorkers
2. Lead Poisoned Adults Egroup (LPAE) http://health.groups.yahoo.com/group/LPAE
3. LPSCs - The Lead Point Source Communities egroup for people living or concerned about lead exposure in lead mining, smelting, manufacturing or recycling communities http://health.groups.yahoo.com/group/LPSCs/
Alternatively, if you don't have a (free) YahooID and don't want to get one, you can contact me and I will happily join you up to any of our egroups.
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Updated 19 February 2013
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