Madder than a Hatter: Controlling the Right Exposure

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Madder than a Hatter Controlling the Right
Exposure Chris van Netten, PhD Health Care and
Epidemiology Karen H. Bartlett, PhD School of
Occupational and Environmental Hygiene
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Worker symptoms

• Eye, nose, and throat irritation
• Headache
• Shortness of breath
• Nausea
• Lightheadedness
• Fatigue

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Worker symptoms

• Interpreted by a local specialist in chelation
  therapy as
• Mercury poisoning

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Diagnosis

• DMPS (2,3-Dimercapto-1-propansulfonic acid)
  provocation urinalysis
• Magic Wand
• Dental amalgams

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Recommended Treatment

• Sick leave, WCB disability claim, etc.
• Remove and replace all amalgam dental fillings
  from workers ()
• Chelation therapy _at_ 1200 per treatment
• Note, several treatments might be necessary

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Experience of one worker

• Sick leave
• Removed and replaced all amalgam fillings ()
• Chelation therapy (1200)
• Did not improve (actually felt worse)
• Conclusion needed another chelation session
  (1200)

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License to practice

• Expert in chelation therapy
• General surgeon (retired)
• Interest in homeopathic medicine
• Magic wand analysis?
• Urinalysis?
• Potential for exposure?

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Magic wand

• Naturopathic and homeopathic tool
• Electrodermal screening

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Electrodermal screening and body scan

• http//www.drwastl.com/files/bodyscan.htm
• Measures skin resistance and translates that into
  exposures to
• Chemicals
• Pesticides
• Herbicides
• Toxic metals, specifically Hg and Pb
• Parasites
• Candida
• And other toxins in your system.
• And at least another 5-6,000 other agents and
  chemicals

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Urinalysis

• DMPS (2,3-Dimercapto-1-propansulfonic acid)
  provocation

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Potential for exposure?

• Dental amalgams concentrating from waste stream
• Illegal disposal of elemental Hg
• Recent report mercury at STP plant
• Spill of mercuric iodide used as reagent to
  determine level of ammonia

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Potential for exposure

• Existing technology mercury sniffer
• Mercury sniffer vs magic wand
• Cost 18,000

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Results of second medical opinion

• Occupational health specialist analysis of
  symptom complex
• Not consistent with Hg poisoning
• Urinalysis
• Within background

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Results of independent exposure analysis

• No mercury exposure under worst conditions
• measured by two independent methods
• Ventilation found to be poor

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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

Already monitored
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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

Bioaerosol exposures
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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

Highly specific disease agents, but not
associated with symptom complex
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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

Associated with high concentration of organic
material
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Occupational STP Exposures

• Hydrogen sulfide
• Ammonia
• Specific chemicals used for disinfection
• Viruses
• Fungi
• Bacteria
• Endotoxin

Associated with high concentrations of Gram
negative bacteria
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Results of pilot study (2002)

• Fungal aerosol
• Outside levels 4670 36000 CFU/m3 (Cladosporium
  Penicillium)
• Inside levels 413 1353 CFU/m3 (Yeast)
• Gram negative bacteria
• Outdoor levels lt 4 CFU/m3
• Indoor (pumping station) 500 - 5950 CFU/m3
• Personal monitoring for Endotoxin
• lt 0.05 EU/m3 to 51 EU/m3

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Sampling strategy (wet well)

• Sampling days Nov 5 14, 2003
• Eight wet wells and Saanich GTB
• Sampled for
• (1) fungal aerosols,
• (2) Gram negative bacteria
• (3) endotoxin
• Day 1 normal
• (1) outdoor control and (2) inside wet well
• Day 2 spray down
• (1) outdoor control and (2) inside wet well

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Fungal Bioaerosols
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Relative composition of fungal genera by operation
Other
Cladosporium
Yeast
Penicillium
Spraying
Outdoor
Normal
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Gram negative bacteria
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Relative sizes of biologic particulate
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Relative sizes of biologic particulate
Pollen Yeast
Fungal spores Gram negative
bacteria Endotoxin Virus particles
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Relative sizes of biologic particulate
Pollen Yeast
Fungal spores Gram negative
bacteria Endotoxin Virus particles
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Lung deposition of biologic particulate
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Lung deposition of biologic particulate
Respiratory tract Nose
Nasopharnyx Trachea
Bronchi Bronchioles
Alveoli
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Lung deposition of biologic particulate
Andersen sampler Respiratory tract Stage 1 (gt 7
um) Nose Stage 2 (4.7
7.0 um) Nasopharnyx Stage 3 (3.3 4.7 um)
Trachea Stage 4 (2.1 3.3 um)
Bronchi Stage 5 (1.1 2.1 um)
Bronchioles Stage 6 (0.65 1.1 um)
Alveoli
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Concentration of biological aerosols by size
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Endotoxins

• Contained in outer cell wall membrane of Gram
  negative bacteria
• Lipopolysaccharide (LPS) with Lipid A moiety
• Heat stable
• Provoke cytokine response in mammals
  (inflammatory response, fever)
• Can cause fatal shock if injected into
  bloodstream

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Endotoxin in wet wells
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Endotoxin in wet wells
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Endotoxin in wet wells
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Endotoxin in wet wells
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Symptom complaints

• Worker symptoms
• Eye, nose, and throat irritation
• Headache
• Shortness of breath
• Nausea
• Lightheadedness
• Fatigue

• Endotoxin exposure
• Mucosal irritation
• Malaise
• Chest tightness
• Cough
• Asthma exacerbation
• Fatigue

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Pumping stations
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Wet wells
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Local exhaust ventilation
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Odour control ventilation
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Spray down
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Historic water levels
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Water levels
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Recommendations

• Improve ventilation characteristics
• Surface extraction
• Prevent air stagnation
• Map air movement
• Wear personal protective equipment
• N-95 mask in high exposure areas
• Practice good personal hygiene

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Rank sites by endotoxin concentration
Fan not operating on test day
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Recommendations - 2

• No North American endotoxin standard yet
• Pilot project ventilation system
• Install water level extraction system
• Test air quality
• Compare to proposed guidelines
• European 200 EU/m3
• American 100 EU/m3
• Dutch expert committee 50 EU/m3